Healthcare Provider Details

I. General information

NPI: 1396083887
Provider Name (Legal Business Name): DANIEL R SKINNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH STREET
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3871
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-851-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN188964
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: