=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407974876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINGLOFF ORTHOPAEDICS P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 02/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 993 JOHNSON FERRY RD NE # C SUITE # 110
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-257-1212
-----------------------------------------------------
Fax | 404-252-7092
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 993 JOHNSON FERRY RD NE # C SUITE # 110
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-257-1212
-----------------------------------------------------
Fax | 404-252-7092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHOPAEDIC SURGEON
-----------------------------------------------------
Name | DR. DANIEL L KINGLOFF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 404-257-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 207X00000X
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------