Healthcare Provider Details

I. General information

NPI: 1154878866
Provider Name (Legal Business Name): DANIEL HANEY PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2016
Last Update Date: 09/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N OAK ST SUITE B-3
VALDOSTA GA
31602-1744
US

IV. Provider business mailing address

3924 CUTTER PT
VALDOSTA GA
31605-7026
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-0100
  • Fax:
Mailing address:
  • Phone: 229-460-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN195429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: