Daniel Michael Tootle, RPH
Individual provider Active NPI Pharmacist · Claxton, GA
NPI 1659489490 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1659489490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 12310 (GA)
- Practice address
- 305 E Long St
Claxton, GA 30417-1411 - Phone
- (912) 739-9393
- Fax
- (912) 739-9033
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12310 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| His Care LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12310 | GA | Yes |
Addresses
Primary practice location
305 E Long St
Claxton, GA 30417-1411
Mailing address
PO Box 577
Claxton, GA 30417-0577
Phone (912) 739-9393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00745775C | Medicaid | GA |
Other providers in Claxton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.