Provider Demographics
NPI:1720227382
Name:WACASEY, DAPHNE M (NP)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:M
Last Name:WACASEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:497 WINN WAY
Mailing Address - Street 2:SUITE A-210
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1754
Mailing Address - Country:US
Mailing Address - Phone:404-294-7033
Mailing Address - Fax:404-296-4661
Practice Address - Street 1:1115 HERRINGTON RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7503
Practice Address - Country:US
Practice Address - Phone:678-990-5260
Practice Address - Fax:678-990-5259
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner