Healthcare Provider Details

I. General information

NPI: 1760423784
Provider Name (Legal Business Name): DANIEL P ALEXANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N CUTHBERT ST
COLQUITT GA
39837-3517
US

IV. Provider business mailing address

208 N CUTHBERT ST
COLQUITT GA
39837-3517
US

V. Phone/Fax

Practice location:
  • Phone: 229-758-3304
  • Fax: 229-758-5946
Mailing address:
  • Phone: 229-758-3304
  • Fax: 229-758-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64885
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: