Provider Demographics
NPI:1770993792
Name:SANDLIN, DANIEL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:SANDLIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1015 LAFAYETTE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3584
Mailing Address - Country:US
Mailing Address - Phone:762-842-0221
Mailing Address - Fax:762-323-1275
Practice Address - Street 1:1015 LAFAYETTE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3584
Practice Address - Country:US
Practice Address - Phone:762-842-0221
Practice Address - Fax:762-323-1275
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA82602208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty