Healthcare Provider Details

I. General information

NPI: 1427131168
Provider Name (Legal Business Name): DANIEL CHARLES TARQUINIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL CHARLES SMITH D.O.

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 JESSE JEWELL PKWY NE STE 300
GAINESVILLE GA
30501-3875
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-6520
  • Fax:
Mailing address:
  • Phone: 770-219-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS10175
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number72932
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number72932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: