Jessie Carl Daniels Sr.
Individual provider Active NPI Driver · Cairo, GA
NPI 1366734667 · NPPES record last updated May 5, 2011
Key facts
- NPI
- 1366734667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 019429298 (GA)
- Practice address
- 207 Sunset LN
Cairo, GA 39828-6741 - Phone
- (229) 378-8922
- NPI assigned
- May 5, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019429298 | GA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 019429298 | GA | Yes |
Addresses
Primary practice location
207 Sunset LN
Cairo, GA 39828-6741
Mailing address
207 Sunset LN
Cairo, GA 39828-6741
Phone (229) 378-8922
Other providers in Cairo, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.