Healthcare Provider Details

I. General information

NPI: 1851363287
Provider Name (Legal Business Name): DARRYL MINOR SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 MEADOW CREEK DR
CUMMING GA
30028-8527
US

IV. Provider business mailing address

5210 MEADOW CREEK DR
CUMMING GA
30028-8527
US

V. Phone/Fax

Practice location:
  • Phone: 678-361-3526
  • Fax: 678-807-8038
Mailing address:
  • Phone: 678-361-3526
  • Fax: 678-807-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: