Healthcare Provider Details

I. General information

NPI: 1801476825
Provider Name (Legal Business Name): GRACE DANIELS CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 01/16/2023
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1820 FERNWOOD RD NW
ATLANTA GA
30318-2514
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3900
  • Fax:
Mailing address:
  • Phone: 843-696-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number11350
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: