Provider Demographics
NPI:1609830363
Name:TRIBBY, DANIEL R (AT-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:TRIBBY
Suffix:
Gender:M
Credentials:AT-C
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:R
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6649
Mailing Address - Country:US
Mailing Address - Phone:770-305-7555
Mailing Address - Fax:770-914-4178
Practice Address - Street 1:105 REGENCY PARK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6649
Practice Address - Country:US
Practice Address - Phone:770-305-7555
Practice Address - Fax:770-914-4178
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0011622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer