Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 080787 | GA |
NPI | 1205071552 |
---|---|
Provider Name | Daniel Lee Maxwell |
First Address | Carrollton, GA 30117-4402 |
Second Address | Carrollton, GA 30117-4402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 04/10/2018 |