Healthcare Provider Details

I. General information

NPI: 1487600771
Provider Name (Legal Business Name): JAMES DANIEL, MD D/B/A WELLSTAR PULMONARY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE SUITE 420
MARIETTA GA
30060-1155
US

IV. Provider business mailing address

55 WHITCHER ST NE SUITE 420
MARIETTA GA
30060-1155
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1372
  • Fax: 770-423-9651
Mailing address:
  • Phone: 770-422-1372
  • Fax: 770-423-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ASHE
Title or Position: EXECUTIVE DIRECTOR OF FINANCE
Credential:
Phone: 770-792-5261