Basic Information
| Provider Information | |||||||||
| NPI: | 1285122085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | MONIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2140 PEACHTREE RD NW STE 232 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788057425 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7031 SW 62ND AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055582500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2018 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | UO7517 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 83728 | GA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.