Healthcare Provider Details

I. General information

NPI: 1851968184
Provider Name (Legal Business Name): MICHAEL DANIEL ANTHONY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 RAVENWOOD CT APT A
ALBANY GA
31701-0141
US

IV. Provider business mailing address

121 RAVENWOOD CT APT A
ALBANY GA
31701-0141
US

V. Phone/Fax

Practice location:
  • Phone: 229-894-6737
  • Fax:
Mailing address:
  • Phone: 229-894-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN259485
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: