Basic Information
| Provider Information | |||||||||
| NPI: | 1942434535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUNG | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | FREDERICK | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2443 | ||||||||
| Address2: | |||||||||
| City: | STATESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304592443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734896691 | ||||||||
| FaxNumber: | 5139815015 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | METTER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304393338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734896691 | ||||||||
| FaxNumber: | 2704414925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2009 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 74967 | GA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 252887-1 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 207P00000X | 74967 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.