Provider Demographics
NPI:1730554007
Name:BLAIR, DANIEL (DO, FACP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DO, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 STONEWOOD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6154
Mailing Address - Country:US
Mailing Address - Phone:423-782-8675
Mailing Address - Fax:
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-5076
Practice Address - Fax:706-475-6676
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204947208D00000X
GA81656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102204947OtherVIRGINIA BOARD OF MEDICINE FOR GENERAL PRACTITIONER