Healthcare Provider Details

I. General information

NPI: 1174277693
Provider Name (Legal Business Name): DANIEL KOTEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 WYESHAM CIR
DULUTH GA
30096-3572
US

IV. Provider business mailing address

PO BOX 2914
DULUTH GA
30096-0050
US

V. Phone/Fax

Practice location:
  • Phone: 678-516-7121
  • Fax:
Mailing address:
  • Phone: 678-516-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN158270
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: