Provider Demographics
NPI:1508955071
Name:GOLIGHTLY, DANIEL P JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:GOLIGHTLY
Suffix:JR
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 1:3188 ATLANTA RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8256
Mailing Address - Country:US
Mailing Address - Phone:770-319-6000
Mailing Address - Fax:770-319-6330
Practice Address - Street 1:3188 ATLANTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8256
Practice Address - Country:US
Practice Address - Phone:770-319-6000
Practice Address - Fax:770-319-6330
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA124702084P0802X
GA012470207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000017509KMedicaid
GA000017509KMedicaid
26BDDFKMedicare ID - Type Unspecified