Provider Demographics
NPI:1508050717
Name:DR. DEBORA DANIEL
Entity Type:Organization
Organization Name:DR. DEBORA DANIEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-949-6300
Mailing Address - Street 1:16931 RANKIN AVE
Mailing Address - Street 2:PO BOX 1389
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-7029
Mailing Address - Country:US
Mailing Address - Phone:423-949-6300
Mailing Address - Fax:423-949-6374
Practice Address - Street 1:16931 RANKIN AVE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7029
Practice Address - Country:US
Practice Address - Phone:423-949-6300
Practice Address - Fax:423-949-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000026084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376890Medicare PIN