Healthcare Provider Details

I. General information

NPI: 1922030105
Provider Name (Legal Business Name): HARVEY J DANITS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 MOUNT ZION RD STE E
MORROW GA
30260-2266
US

IV. Provider business mailing address

1115 MOUNT ZION RD STE E
MORROW GA
30260-2266
US

V. Phone/Fax

Practice location:
  • Phone: 770-960-9999
  • Fax: 770-960-0931
Mailing address:
  • Phone: 770-960-9999
  • Fax: 770-960-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number015242
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000509539C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: