Basic Information
| Provider Information | |||||||||
| NPI: | 1952568370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOARES | ||||||||
| FirstName: | DANNY | ||||||||
| MiddleName: | JOSE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1402 AZALEA GARDEN DR | ||||||||
| Address2: | |||||||||
| City: | DUNWOODY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303387909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035180201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4553 N SHALLOWFORD RD | ||||||||
| Address2: | SUITE 20B | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704576303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 07/25/2013 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207YS0123X | 69259 | GA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
No ID Information.