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NPI Code Detail

MEDICARE: DR. MARK LASSITER DANIEL M.D.

MEDICARE: DR. MARK LASSITER DANIEL M.D.
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
1207Q00000XFamily Medicine Physician028759GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700883659
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK LASSITER DANIEL M.D.
Provider Business Mailing Address
First Line : 109 COLLEGE AVE
Second Line :
City : ELBERTON
State : GA
Zip : 30635-1705
Country : US
Telephone Number : 706-283-3315
Fax Number : 706-283-2159
Provider Business Practice Location Address
First Line : 109 COLLEGE AVE
Second Line :
City : ELBERTON
State : GA
Zip : 30635-1705
Country : US
Telephone Number : 706-283-3315
Fax Number : 706-283-2159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 01/05/2010

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