Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 395 | GA |
Y | 222Z00000X | Podiatrist | 395 | GA |
N | 213ES0131X | Foot Surgery | 395 | GA |
NPI | 1366513905 |
---|---|
Provider Name | Wesley Lewis Daniel |
First Address | Gainesville, GA 30501-2034 |
Second Address | Gainesville, GA 30501-2034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 25/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00064435A | (05) | GA |
U22257 | (02) | GA |