Provider Demographics
NPI:1689163685
Name:DASHER, DANIEL LAUREN (MSPA, PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LAUREN
Last Name:DASHER
Suffix:
Gender:M
Credentials:MSPA, PA-C
Other - Prefix:
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Mailing Address - Street 1:210 MOSE COLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8677
Mailing Address - Country:US
Mailing Address - Phone:912-537-2200
Mailing Address - Fax:912-537-2260
Practice Address - Street 1:210 MOSE COLEMAN DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8677
Practice Address - Country:US
Practice Address - Phone:912-537-2200
Practice Address - Fax:912-537-2260
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA8752363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical