Healthcare Provider Details

I. General information

NPI: 1346688017
Provider Name (Legal Business Name): DANIEL PHILIP WITTER I M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 OVERHILL PASS
STOCKBRIDGE GA
30281-5889
US

IV. Provider business mailing address

305 OVERHILL PASS
STOCKBRIDGE GA
30281-5889
US

V. Phone/Fax

Practice location:
  • Phone: 352-870-2916
  • Fax:
Mailing address:
  • Phone: 352-870-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME122713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: