Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1154729333 |
---|---|
Provider Name | Ms. Katie C Daniels |
First Address | Darien, GA 31305-9151 |
Second Address | Darien, GA 31305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2014 |
Last Update Date | 19/12/2014 |