Individual
DANIELLE M NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1365 ROCK QUARRY RD STE 300, STOCKBRIDGE, GA 30281-5024
(770) 740-1860
(678) 347-2104
Mailing address
925 N POINT PKWY, STE 130, ALPHARETTA, GA 30005-5211
(770) 740-1860
(678) 347-2104
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8750
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1151025
NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS CERTIFICATION
—
01
—
8750
GEORGIA COMPOSITE MEDICAL BOARD STATE LICENSURE
GA
Enumeration date
05/29/2018
Last updated
09/20/2018
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