Healthcare Provider Details

I. General information

NPI: 1831132968
Provider Name (Legal Business Name): DANIEL D TAFFE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 PEACHTREE INDUSTRIAL BLVD SUITE 300
BERKELEY LAKE GA
30092-3015
US

IV. Provider business mailing address

4775 PEACHTREE INDUSTRIAL BLVD SUITE 300
BERKELEY LAKE GA
30092-3015
US

V. Phone/Fax

Practice location:
  • Phone: 800-780-3500
  • Fax: 770-246-0882
Mailing address:
  • Phone: 800-780-3500
  • Fax: 770-246-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number347
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: