Provider Demographics
NPI:1154624013
Name:FLOYD, KANANI DANIELS (PA-C)
Entity type:Individual
Prefix:
First Name:KANANI
Middle Name:DANIELS
Last Name:FLOYD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 PARKE PLAZA CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3637
Mailing Address - Country:US
Mailing Address - Phone:770-469-7000
Mailing Address - Fax:770-879-0436
Practice Address - Street 1:1805 PARKE PLAZA CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3637
Practice Address - Country:US
Practice Address - Phone:770-469-7000
Practice Address - Fax:770-879-0436
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05335363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical