Healthcare Provider Details

I. General information

NPI: 1235528415
Provider Name (Legal Business Name): DANIEL BRYCE SKIPPER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 HISTORIC HWY #441-N
DEMOREST GA
30535
US

IV. Provider business mailing address

363 NORTHWOODS DR
MOUNT AIRY GA
30563-2260
US

V. Phone/Fax

Practice location:
  • Phone: 706-754-2161
  • Fax:
Mailing address:
  • Phone: 912-381-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.19235 APRN
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: