Healthcare Provider Details

I. General information

NPI: 1013360932
Provider Name (Legal Business Name): HODA DAHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 HOSPITAL DR NE
COVINGTON GA
30014-2566
US

IV. Provider business mailing address

5380 TECH DATA DR STE 101
CLEARWATER FL
33760-3122
US

V. Phone/Fax

Practice location:
  • Phone: 770-786-7053
  • Fax:
Mailing address:
  • Phone: 727-437-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82927
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301110008
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: