Provider Demographics
NPI:1548371503
Name:DANIEL, GEORGIA DAWN (APRN)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:DAWN
Last Name:DANIEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:120 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:304-624-0026
Practice Address - Street 1:120 MEDICAL PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-624-7200
Practice Address - Fax:304-624-0026
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV29466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9600228000Medicaid
WVS78469Medicare UPIN
WV9600228000Medicaid
PA107703V46Medicare PIN