Individual
MITHUN SAM DANIEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D. O.
Contact information
Practice address
960 JOHNSON FY RD NE, SUITE 300, ATLANTA, GA 30342-1631
(404) 255-7325
(404) 255-3055
Mailing address
960 JOHNSON FY RD NE, SUITE 300, ATLANTA, GA 30342-1631
(404) 255-7325
(404) 255-3055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
075104
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/26/2013
Last updated
10/15/2020
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