Basic Information
| Provider Information | |||||||||
| NPI: | 1538622873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | DUONG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 MAPMAKER LN | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314102007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9122247055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1459 LANEY WALKER BLVC AE-3042 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067216715 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2019 | ||||||||
| LastUpdateDate: | 04/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 10822 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.