Provider Demographics
NPI:1184611774
Name:DANIEL, ANNAMMA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNAMMA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 EAST BROOK BEND
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269
Mailing Address - Country:US
Mailing Address - Phone:770-487-3330
Mailing Address - Fax:770-487-7736
Practice Address - Street 1:19 EAST BROOK BEND
Practice Address - Street 2:SUITE 200
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269
Practice Address - Country:US
Practice Address - Phone:770-487-3330
Practice Address - Fax:770-487-7736
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453439208000000X
NY242338-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD004286200Medicaid