=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114186020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANK J. D'ANNA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2008
-----------------------------------------------------
Last Update Date | 07/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 LAKESHORE DR SUITE B
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31558-3874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-729-2955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 LAKESHORE DR SUITE B
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31558-3874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-729-2955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR/PRESIDENT
-----------------------------------------------------
Name | DR. FRANK JOSEPH D'ANNA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 912-729-2955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | 036952
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------