Individual
DR. MARK LASSITER DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
109 COLLEGE AVE, ELBERTON, GA 30635-1705
(706) 283-3315
(706) 283-2159
Mailing address
109 COLLEGE AVE, ELBERTON, GA 30635-1705
(706) 283-3315
(706) 283-2159
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
028759
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00370532A
—
GA
Enumeration date
07/07/2005
Last updated
01/05/2010
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