Provider Demographics
NPI:1699815225
Name:BOSSO, DANIEL GEOFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GEOFFREY
Last Name:BOSSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S ENOTA DR NE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2400
Mailing Address - Country:US
Mailing Address - Phone:770-219-7826
Mailing Address - Fax:
Practice Address - Street 1:597 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2545
Practice Address - Country:US
Practice Address - Phone:770-219-8102
Practice Address - Fax:770-219-7778
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36654207P00000X
GA066761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO98641OtherAR BLUE SHIELD #
MO247970015Medicaid
MO247970015Medicaid
MOE54922Medicare UPIN