Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 012470 | GA |
NPI | 1508955071 |
---|---|
Provider Name | Daniel P Golightly JR. |
First Address | Smyrna, GA 30080-8256 |
Second Address | Smyrna, GA 30080-8256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000017509K | (05) | GA |
D39977 | (02) |