Provider Demographics
NPI:1114960382
Name:SERRATO, DANIEL HENRY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HENRY
Last Name:SERRATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9456
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9456
Mailing Address - Country:US
Mailing Address - Phone:706-322-7246
Mailing Address - Fax:706-596-2115
Practice Address - Street 1:7141 MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3137
Practice Address - Country:US
Practice Address - Phone:706-322-7246
Practice Address - Fax:706-596-2115
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30885208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00460171DMedicaid
GA650207OtherBCBS PROVIDER ID
GAGRP3215Medicare ID - Type UnspecifiedPROVIDER NUMBER
GA00460171DMedicaid