DIANE L SPIVA (NPI# 1578632808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578632808 |
| Entity Type | Individual |
| Full Name | DIANE L SPIVA |
| Credential | CRNP |
| Practice Address |
10730 Medlock Bridge Rd Ste 110 Johns Creek GA 30097-2638 |
| Mailing Address |
1557 Janmar Rd Snellville GA 30078-5686 |
| Practice Telephone | 6783448900 |
| Practice Fax Number | 6786665201 |
| Mailing Telephone | 6783448900 |
| Mailing Fax Number | 6786665201 |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2019-03-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
1-117580 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
RN278076 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
1-117580 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
1-117580 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 367500000X | Nurse Anesthetist, Certified Registered | 55532 | KS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | CRNP LICENSE | 1-117580 | 01 |
| KS | RNA LICENSE | 55532 | 01 |
| GA | APRN LICENSE | RN278076 | 01 |
| KS | RN LICENSE | 1391784012 | 01 |
| AL | RN LICENSE | 1-117580 | 01 |
| GA | RN LICENSE | RN278076 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11660 Alpharetta Hwy, Roswell, GA 300764943 | 6783448900 | 6786665201 |
| Street Address |
10730 MEDLOCK BRIDGE RD STE 110 |
| City | JOHNS CREEK |
| State | GA |
| Zip Code | 30097-2638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730283284 | Vahan S Kassabian | Urology | 10730 Medlock Bridge Rd Ste 110, Johns Creek, GA 30097-2638 | 2006-09-12 |
| 1538636592 | Elena Victoria Garifallou | Physician Assistant | 10730 Medlock Bridge Rd Ste 110, Johns Creek, GA 30097 | 2018-10-29 |
| 1831505361 | Andrew Kenneth Ostrowski | Urology | 10730 Medlock Bridge Rd Ste 110, Johns Creek, GA 30097-2638 | 2014-07-03 |
| 1265843312 | Jason Lomboy | Urology | 10730 Medlock Bridge Rd Ste 110, Johns Creek, GA 30097-2638 | 2014-05-12 |
| 1881808947 | Timothy Casey Mccullough | Urology | 10730 Medlock Bridge Rd Ste 110, Johns Creek, GA 30097 | 2007-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659986057 | Herman Medical Solutions, LLC | Internal Medicine | 10700 Medlock Bridge Road, Suite 207, Duluth, GA 30097 | 2020-09-11 |
| 1649808619 | Kirsty Amber Ramirez | Behavior Technician | 218 Premiere Pkwy #500, Duluth, GA 30097 | 2020-03-27 |
| 1386277820 | Cristina Madalina Niculas | Pharmacist | Kroger Pharmacy 476, 6555 Sugarloaf Parkway, Duluth, GA 30097 | 2020-02-12 |
| 1619514924 | Opesdei Health Solutions | Home Health Aide | 6615 Abbotts Bridge Road, 6615 Abbotts Bridge Road Unit 1111, Johns Creek, GA 30097 | 2019-12-05 |
| 1700422979 | Ria Alexander | Nurse Practitioner | 6300 Hospital Parkway Ste 300, Johns Creek, GA 30097 | 2019-11-22 |
| 1043867765 | Mosesal Zakia White | Nurse Practitioner | 10680 Medlock Bridge Rd #102, Johns Creek, GA 30097 | 2019-08-19 |
| 1982187068 | Lighthouse Clinical Counseling, LLC | Counselor | 3883 Rogers Bridge Road, Suite 601, Duluth, GA 30097 | 2018-09-13 |
| 1376025643 | Faithe Beanne Kimsey | Counselor | 3883 Rogers Bridge Road Nw, Suite 601, Duluth, GA 30097 | 2018-09-04 |
| 1306330303 | Denise Jackson | Prosthetist | 11720 Medlock Bridge Rd Ste 155, Johns Creek, GA 30097 | 2018-06-21 |
| 1407363328 | Berkeley Van Dyke | Physical Therapist | 6335 Hospital Pkwy Ste 316, Johns Creek, GA 30097 | 2017-12-30 |
| Find all providers in zip 30097 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043867765 | Mosesal Zakia White | Nurse Practitioner | 10680 Medlock Bridge Rd #102, Johns Creek, GA 30097 | 2019-08-19 |
| 1508412453 | Eugeniu Boris Cucuta | Nurse Practitioner | 3000 Old Alabama Rd Ste 128a, Johns Creek, GA 30022-1901 | 2019-08-16 |
| 1487121679 | Michelle Chun | Nurse Practitioner | 10710 Medlock Bridge Rd Ste 150, Johns Creek, GA 30097-2440 | 2018-10-26 |
| 1912492489 | Kelsey Rolwood | Nurse Practitioner | 11705 Jones Bridge Rd Ste A201, Johns Creek, GA 30005-5080 | 2018-06-27 |
| 1538553623 | Hanna Lee Park | Nurse Practitioner | 11459 Johns Creek Pkwy Ste 250, Johns Creek, GA 30097-3517 | 2015-03-26 |
| 1902108491 | Roseline Makinde | Nurse Practitioner | 5808 State Bridge Rd, Johns Creek, GA 30097-6476 | 2010-12-03 |
| 1902448012 | Melanie Carroll Steen | Nurse Practitioner | 10692 Medlock Bridge Rd Ste 100a, Johns Creek, GA 30097-8497 | 2019-10-09 |
| 1922595099 | Jennifer Rosson | Nurse Practitioner | 6300 Hospital Pkwy Ste 375, Johns Creek, GA 30097-2461 | 2018-04-15 |
| 1205334661 | Vy Vy Ann Thi Pham | Nurse Practitioner | 11705 Jones Bridge Rd, Johns Creek, GA 30005-5078 | 2018-01-30 |
| 1174048474 | Monique Jennifer Stage | Nurse Practitioner | 11459 Johns Creek Pkwy Ste 250, Johns Creek, GA 30097-3517 | 2017-08-08 |
| Find all providers in JOHNS CREEK | ||||
| City | JOHNS CREEK |
| Zip Code | 30097 |
Please comment or provide details below to improve the information on DIANE L SPIVA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.