Waddah A Diab, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

11344 Issued in GA

Practice address

3900 Frey Rd NW
Suite 102
Kennesaw, GA 30144-5408

Phone

(770) 426-1062

NPI assigned

May 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Wade A Diab Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609823772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3900 FREY RD NW",
            "address_2": "SUITE 102",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445408",
            "telephone_number": "770-426-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 FREY RD NW",
            "address_2": "SUITE 102",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301445408",
            "telephone_number": "770-426-1062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAB",
        "first_name": "WADDAH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "11344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WADE",
            "last_name": "DIAB",
            "middle_name": "A",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Douglas Jay Deuchar, D.M.D.
• Lydia L. Dever, DC
• Devereux Foundation
• Devereux Georgia
• Devereux Goergia Treatment Network
• Diabetic Soles, Inc
• Adama Y. Diallo
• Kristina Diaz
• Digitrace Care Services
• Emery Delancey Dikeman, MSN, APRN, CPNP-PC

• Periodontics in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.