=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568060259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL PAUL DOSSETT PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2020
-----------------------------------------------------
Last Update Date | 11/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 GUNN RD
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31028-8045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-953-8118
-----------------------------------------------------
Fax | 478-953-5527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5801 ZEBULON RD UNIT 409
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31210-2392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-954-4754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 032025
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------