Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 020093 | GA |
NPI | 1003833666 |
---|---|
Provider Name | Thomas Danello |
First Address | Savannah, GA 31406-3659 |
Second Address | Savannah, GA 31406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D45165 | (02) | GA |