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Jennifer Carlita Peters-Diamond

Family Medicine

Allopathic & Osteopathic Physicians

111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027

(423) 723-2030 (423) 408-7220

PECOS Enrollment

This provider is enrolled in PECOS as JENNIFER PETERS.

Based on the most recent information from CMS, provider Jennifer Carlita Peters-Diamond is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1578640561
Provider Type
Individual
Full Name
Peters-Diamond, Jennifer Carlita
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
11/1/2006
Last Updated
8/19/2024

Contact Information

Practice Location

111 W Stone Dr, Suite 110, Kingsport, TN 37660-6027

(423) 723-2030

(423) 247-4110

Mailing Location

105 W Stone Dr, Suite 6a, Kingsport, TN 37660-3365

(423) 408-7220

(423) 408-7405

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 48169 Tennessee
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License 0101240169 Virginia

Provider Identifiers

ID	Description	Issuer
ID 007604092	Description Medicaid	Issuer Unlisted Virginia

Jennifer Carlita Peters-Diamond

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Rajoo, Shari K

Brown, Dana Steven

Delwadia, Andy

Harman, Eric W

Vaughn, Jeffrey

Cooper, Gregory J

Robbins, Sherry L

Platzer, Peter B

Miranda, Renee May Sayson

Rose, Douglas J.