Healthcare Provider Details

I. General information

NPI: 1730554007
Provider Name (Legal Business Name): DANIEL BLAIR DO, FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 04/14/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

2280 STONEWOOD FIELD RD
WATKINSVILLE GA
30677-6154
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5076
  • Fax: 706-475-6676
Mailing address:
  • Phone: 423-782-8675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81656
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102204947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: