Poonam Datta

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

5675 Jimmy Carter Blvd Ste 665a
Norcross, GA 30071-2955

Phone

(770) 317-4533

NPI assigned

Feb 12, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1518393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1912406307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 BUTLER NATIONAL DR",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300975944",
            "telephone_number": "770-317-4533",
            "fax_number": "844-461-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5675 JIMMY CARTER BLVD STE 665A",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300712955",
            "telephone_number": "770-317-4533"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2769 Duluth Hwy",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "GA",
            "postal_code": "300964019",
            "country_code": "US",
            "telephone_number": "770-317-4533",
            "fax_number": "844-461-5939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DATTA",
        "first_name": "POONAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-12",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheney Christian Daniel, D.C.
• Mark Lewis Daniel, DC
• Irene Daniels
• Kirsten Laine Daniels, NP
• Uyen Phuong Dao, PHARMD
• Sarah Elizabeth Daughtry, COTA/L
• Bethany Davidson
• Albradella Regina Davis, PT
• Barbara Nicole Davis, FNP-C, GNP-BC
• Carly Marie Davis, SLP

• Community Health Worker in Norcross, GA
• Providers in Norcross, GA by specialty
• Community Health Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.