Healthcare Provider Details

I. General information

NPI: 1982922498
Provider Name (Legal Business Name): DANIEL AUBREY GRACE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 BROADRICK DR
DALTON GA
30720-3009
US

IV. Provider business mailing address

1432 BROADRICK DR
DALTON GA
30720-3009
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-8990
  • Fax: 706-529-5313
Mailing address:
  • Phone: 706-226-8990
  • Fax: 706-529-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019013765
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number201401212
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: