Individual
DANIEL ADRIAN FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3011 HAMPTON AVE, BRUNSWICK, GA 31520-4264
(912) 261-2669
(912) 261-0561
Mailing address
3011 HAMPTON AVE, BRUNSWICK, GA 31520-4264
(912) 261-2669
(912) 261-0561
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
062687
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP2-0021332
INSTITUTIONAL PERMIT
—
Enumeration date
06/09/2007
Last updated
08/19/2009
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