Provider Demographics
NPI:1104821065
Name:KINGLOFF, DANIEL L (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:KINGLOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993C JOHNSON FERRY RD NE
Mailing Address - Street 2:STE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4747
Mailing Address - Country:US
Mailing Address - Phone:404-257-1212
Mailing Address - Fax:404-252-7092
Practice Address - Street 1:993C JOHNSON FERRY RD NE
Practice Address - Street 2:STE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4747
Practice Address - Country:US
Practice Address - Phone:404-257-1212
Practice Address - Fax:404-252-7092
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019396207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4460180001Medicare NSC
GAD29935Medicare UPIN