Provider Demographics
NPI:1922105014
Name:DANIEL, MARK G (PA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:G
Last Name:DANIEL
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Gender:M
Credentials:PA
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Mailing Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2208
Mailing Address - Country:US
Mailing Address - Phone:404-778-3347
Mailing Address - Fax:404-778-7117
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:SUITE 2000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-3347
Practice Address - Fax:404-778-7117
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA1634363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR94556Medicare UPIN