Active NPI
Jordan Daniels
- Surgical Assistant
- Lilburn, GA
National Provider Identifier
1801611884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 23-639
- Practice address
- 1081 Oak Rd SW
Lilburn, GA 30047-1866 - Phone
- (201) 539-5934
- NPI assigned
- Nov 15, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 23-639 | GA | Primary |
Addresses
Primary practice location
1081 Oak Rd SW
Lilburn, GA 30047-1866
Mailing address
1081 Oak Rd SW
Lilburn, GA 30047-1866
Phone (201) 539-5934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-639 | GA | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731628800000",
"number": "1801611884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1081 OAK RD SW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300471866",
"telephone_number": "201-539-5934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1081 OAK RD SW",
"city": "LILBURN",
"state": "GA",
"postal_code": "300471866",
"telephone_number": "201-539-5934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIELS",
"first_name": "JORDAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-15",
"last_updated": "2024-11-15",
"certification_date": "2024-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "GA",
"license": "23-639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lilburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.