Individual
ITORO BASSEY EDET DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
803 S MAIN ST, GREENSBORO, GA 30642
(706) 454-5114
(706) 454-5199
Mailing address
803 S MAIN ST, GREENSBORO, GA 30642-1211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
080742
GA
207R00000X
Internal Medicine Physician
R73852
AZ
208000000X
Pediatrics Physician
R73852
AZ
Other
Enumeration date
05/13/2013
Last updated
09/08/2022
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