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General NPI Number Information
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NPI Number | 1093361602
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Entity Type | Individual
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Provider Name | DANIEL ZAVADIL
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Gender | Male
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Dates
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Enumeration Date | 08/11/2019
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 135 N PARK PL STE 101
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7237
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Country | US
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Telephone | 770-892-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 135 N PARK PL STE 101
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7237
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Country | US
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Telephone | 757-274-7117
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10416
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License Number State | GA
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