Provider Demographics
NPI:1417485608
Name:CADAVID DUQUE, DANIEL (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:CADAVID DUQUE
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 VERNEER CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3620
Mailing Address - Country:US
Mailing Address - Phone:404-729-3614
Mailing Address - Fax:
Practice Address - Street 1:684 SIXES RD STE 130
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-8758
Practice Address - Country:US
Practice Address - Phone:770-517-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0029872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer