DIVERSIFIED DIAGNOSTICS, INC (NPI# 1790194066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790194066 |
| Entity Type | Organization |
| Organization Name | DIVERSIFIED DIAGNOSTICS, INC |
| Practice Address |
2440 Sandy Plains Rd Suite 115 Marietta GA 30066-7217 |
| Practice Telephone | 6789061634 |
| Mailing Telephone | 6789061634 |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |
| Authorized Official Name | MR. MAKSIM PERLIN (PRESIDENT) |
| Authorized Official Telephone | 6789061634 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | Managed Care Organizations |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | DIVERSIFIED DIAGNOSTICS, INC. | 2050 Nichols Landing Way, Dacula, CT 30019 |
| Street Address |
2440 SANDY PLAINS RD SUITE 115 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30066-7217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871571190 | Natalie Parra Kutscher | Speech-Language Pathologist | 2440 Sandy Plains Rd, Building 13 Suite 100, Marietta, GA 30066-3408 | 2006-01-06 |
| 1033655287 | Jennifer Harbin | Counselor | 2440 Sandy Plains Rd, Building 2, Suite 100, Marietta, GA 30066-4695 | 2017-01-12 |
| 1164965901 | Sabrina Betts | Counselor | 2440 Sandy Plains Rd, Building 3, Suite 115, Marietta, GA 30066-7217 | 2016-11-28 |
| 1598216061 | Marietta Counseling | Clinic/Center | 2440 Sandy Plains Rd, Bldg #25, Marietta, GA 30066-7217 | 2016-10-20 |
| 1588114789 | Cecil Davison II | Counselor | 2440 Sandy Plains Rd, Bldg 25, Marietta, GA 30066-7217 | 2016-10-11 |
| 1386197994 | A Place of Purpose, Inc. | Community/Behavioral Health | 2440 Sandy Plains Rd, Building 3, Suite 115, Marietta, GA 30066-7217 | 2016-07-31 |
| 1457709735 | Joseph Scott Pennington | Counselor | 2440 Sandy Plains Rd, Marietta, GA 30066-7217 | 2016-05-27 |
| 1972971521 | Alexander Kohl | Counselor | 2440 Sandy Plains Rd, Building 25, Marietta, GA 30066-7217 | 2015-09-11 |
| 1083081798 | Crista Engelson | Marriage & Family Therapist | 2440 Sandy Plains Rd, Building 25, Marietta, GA 30066-7217 | 2015-08-28 |
| 1619391893 | Progressive Health Services LLC | Health Maintenance Organization | 2440 Sandy Plains Rd, Blg 21, Suite 100, Marietta, GA 30066-7217 | 2014-02-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598253684 | Comfort Community Center, LLC | Skilled Nursing Facility | 2440 Sandy Plains Road, Blvd 21, Suite 100, Marietta, GA 30066 | 2018-04-25 |
| 1538681994 | Passionate Care | In Home Supportive Care | 1110 Renfro Ln., Marietta, GA 30066 | 2017-07-07 |
| 1437510443 | Steven Caras | Internal Medicine | 2682 Bonaire Terrace, Marietta, GA 30066 | 2016-03-18 |
| 1275918781 | Latifat Bolajoko Asemota | Nurse Practitioner | 410 Nottingham Dr, Marietta, GA 30066 | 2015-07-26 |
| 1497094205 | Changing Phases Behavioral Support, Inc | Internal Medicine | 3655 Canton Rd Ste 201, Marietta, GA 30066 | 2013-02-14 |
| 1659618916 | Alison Nicole Sims | Occupational Therapist | 2465 Canopy Drive, Marietta, GA 30066 | 2013-01-07 |
| 1790044907 | Antoine Jose Davenport | Massage Therapist | 4686 Jamerson Creek Dr, Marietta, GA 30066 | 2012-05-08 |
| 1174898548 | Angel Elizabeth Nofziger | Nurse Practitioner | 3750 Palladian Village Dr Ste 300, Marietta, GA 30066 | 2012-03-18 |
| 1912298019 | Nancy Jean Slack | Pharmacist | 2833 Canton Road, Marietta, GA 30066 | 2011-04-22 |
| 1336456078 | Mario B Miller Sr. | Chiropractor | 50 Barrett Parkway, Suite 3005#126, Marietta, GA 30066 | 2010-09-01 |
| Find all providers in zip 30066 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
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| 1801204409 | Yvonne G. Jarrett | Point of Service | 2651 Flintlock Ln Sw, Marietta, GA 30008-5016 | 2014-07-27 |
| 1750763132 | Primary Medical Homecare LLC | Point of Service | 2480 Windy Hill Rd Se, Suite 206, Marietta, GA 30067-8644 | 2015-06-23 |
| 1447483730 | Spelios and Associates- Summitt PC | Point of Service | 3823 Roswell Rd, Suite 205, Marietta, GA 30062-6278 | 2009-09-02 |
| 1316098965 | Spelios and Associates Delk Road PC | Point of Service | 2759 Delk Rd Se, Suite 105, Marietta, GA 30067-8847 | 2007-01-12 |
| 1437219656 | Wellstar Health System, Inc. | Point of Service | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2006-12-11 |
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| 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.