MEDICARE: DANIELLE HUNT ORTEGA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5151013349	MI
2	207Q00000X	Family Medicine Physician	95545	GA

General Provider Information

NPI Number	:	1619408051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE HUNT ORTEGA DO

Provider Business Mailing Address
First Line	:	3890 REDWINE RD SW STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5583
Country	:	US
Telephone Number	:	404-344-0059
Fax Number	:	404-344-9195

Provider Business Practice Location Address
First Line	:	3890 REDWINE RD SW STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5583
Country	:	US
Telephone Number	:	404-344-0059
Fax Number	:	404-344-9195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	09/06/2023

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