Healthcare Provider Details

I. General information

NPI: 1932562154
Provider Name (Legal Business Name): DANIEL AVERY PIERCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 OLD LEXINGTON RD
THOMASVILLE NC
27360-3428
US

IV. Provider business mailing address

PO BOX 936857
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 336-474-8153
  • Fax: 336-474-8159
Mailing address:
  • Phone: 336-474-8153
  • Fax: 336-474-8159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2022-01622
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2022-01622
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: