Healthcare Provider Details

I. General information

NPI: 1659748077
Provider Name (Legal Business Name): MICHAEL DALY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FAIR RD
STATESBORO GA
30458-1683
US

IV. Provider business mailing address

PO BOX 386
SPRINGFIELD GA
31329-0386
US

V. Phone/Fax

Practice location:
  • Phone: 912-486-1433
  • Fax: 912-871-2261
Mailing address:
  • Phone: 912-754-0182
  • Fax: 912-754-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN218021
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP218021
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: