Provider Demographics
NPI:1457717332
Name:WILLETT, DANIEL LEE (CNIM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:WILLETT
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:420 CHARTER BLVD STE 402A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4854
Mailing Address - Country:US
Mailing Address - Phone:404-617-7143
Mailing Address - Fax:855-940-0206
Practice Address - Street 1:420 CHARTER BLVD STE 402A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4854
Practice Address - Country:US
Practice Address - Phone:404-617-7143
Practice Address - Fax:855-940-0206
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic