Healthcare Provider Details

I. General information

NPI: 1396494845
Provider Name (Legal Business Name): DANIEL EDUARDO ORGANISTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HERRELL RD
VILLA RICA GA
30180-5527
US

IV. Provider business mailing address

20 HERRELL RD
VILLA RICA GA
30180-5527
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-3530
  • Fax: 770-812-3531
Mailing address:
  • Phone: 770-812-3530
  • Fax: 770-812-3531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number113406
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: