Provider Demographics
NPI:1235163114
Name:BELESS, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:BELESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1341 CANTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6056
Mailing Address - Country:US
Mailing Address - Phone:770-422-0517
Mailing Address - Fax:678-638-7015
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE G-9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:678-229-2800
Practice Address - Fax:404-845-9989
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA023424163WW0000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00439392EMedicaid
F09566Medicare UPIN
GA00439392EMedicaid