Healthcare Provider Details

I. General information

NPI: 1902760960
Provider Name (Legal Business Name): IRENE DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 GEORGIA BELLE CT STE 2071
NORCROSS GA
30093-2667
US

IV. Provider business mailing address

5030 GEORGIA BELLE CT STE 2071
NORCROSS GA
30093-2667
US

V. Phone/Fax

Practice location:
  • Phone: 770-638-5700
  • Fax: 866-231-8191
Mailing address:
  • Phone: 770-638-5700
  • Fax: 866-231-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP256376
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: