Provider Demographics
NPI:1396037057
Name:DANIELSON, JILL BRANNAN (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:BRANNAN
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DR
Mailing Address - Street 2:STE 360
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3367
Mailing Address - Country:US
Mailing Address - Phone:404-235-6822
Mailing Address - Fax:
Practice Address - Street 1:631 PROFESSIONAL DR
Practice Address - Street 2:SUITE 360
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3367
Practice Address - Country:US
Practice Address - Phone:770-962-4895
Practice Address - Fax:770-962-4792
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN060090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily