Healthcare Provider Details

I. General information

NPI: 1184611774
Provider Name (Legal Business Name): ANNAMMA DANIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 EAST BROOK BEND SUITE 200
PEACHTREE CITY GA
30269
US

IV. Provider business mailing address

19 EAST BROOK BEND SUITE 200
PEACHTREE CITY GA
30269
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-3330
  • Fax: 770-487-7736
Mailing address:
  • Phone: 770-487-3330
  • Fax: 770-487-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD453439
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: