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Individual

DARYL JACOB

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CAA

Contact information

Practice address
111 MICHIGAN AVE NW, WASHINGTON, DC 20010-2916
(888) 884-2327
Mailing address
1968 PEACHTREE RD NW, ATLANTA, GA 30309-1281

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
AA000080
DC
367H00000X
Anesthesiologist Assistant
7680
GA
367H00000X
Anesthesiologist Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AA000080
NCCAA CERTIFICATION
DC
Enumeration date
08/07/2015
Last updated
02/06/2020
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