Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 20121 | GA |
NPI | 1033415252 |
---|---|
Provider Name | Dr. Daniel James Hennessy |
First Address | Atlanta, GA 30328-3558 |
Second Address | Atlanta, GA 30328-3558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2011 |
Last Update Date | 04/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20121 | GEORGIA (01) | GA |