Basic Information
| Provider Information | |||||||||
| NPI: | 1629262407 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIELL | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | Q | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT ROAD NE | ||||||||
| Address2: | NINE PIEDMONT CENTER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049495019 | ||||||||
| FaxNumber: | 4043644985 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 CRESCENT CENTRE PARKWAY | ||||||||
| Address2: | CRESCENT MEDICAL CENTTER DPT OF ADULT MEDICINE | ||||||||
| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300847047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704963414 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 040648 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00842014(X) | 05 | GA | MEDICAID |