Mithun Sam Daniel, D. O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

075104 Issued in GA

Practice address

960 Johnson Fy Rd NE
Suite 300
Atlanta, GA 30342-1631

Phone

(404) 255-7325

Fax

(404) 255-3055

NPI assigned

Jun 26, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mithun Daniel Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mithundaniel@pnfm.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  Medicare reassignment NPD
• Judith Ruth Medical Center LLC

  • Family Nurse Practitioner
  • Lithia Springs, GA
  • NPI 1144912270
  Medicare reassignment
• MC Medical LLC

  • General Practice Physician
  • Dallas, GA
  • NPI 1356907695
  NPD
• Perimeter North Family Practice LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1295936318
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1508206319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FY RD NE",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-255-7325",
            "fax_number": "404-255-3055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FY RD NE",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421631",
            "telephone_number": "404-255-7325",
            "fax_number": "404-255-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIEL",
        "first_name": "MITHUN",
        "middle_name": "SAM",
        "credential": "D. O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "075104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mithundaniel@pnfm.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct edge",
            "address_1": "960 Johnson Fy Rd NE",
            "address_2": "Suite 300",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303421631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MITHUN",
            "last_name": "DANIEL",
            "credential": "DO",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kikeade Adedayo Daniel
• Kimberly Y Daniel, CRNA
• Lance Daniel, RBT
• Marilyn Sue Daniel, LPC
• Mark G Daniel, PA
• Sabrina Ann Daniel, NP-C
• Sharon V Daniel, D.D.S.
• Taylor F Daniel, NP
• Yoshie Daniel, PHYSICIAN ASSISTANT
• Amara Siddique Danielczok, MD, MS, FAAP

• Family Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.