=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184790818
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL BENJAMIN KATZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 677 HWY 441 S SUITE C
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-782-3135
-----------------------------------------------------
Fax | 706-782-1375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1225
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-782-3135
-----------------------------------------------------
Fax | 706-782-1375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | 044763
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------