Provider Demographics
NPI:1194713016
Name:RABB, DANIEL C (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:RABB
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 S ENOTA DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2429
Mailing Address - Country:US
Mailing Address - Phone:770-536-7546
Mailing Address - Fax:678-343-2006
Practice Address - Street 1:974 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2429
Practice Address - Country:US
Practice Address - Phone:770-536-7546
Practice Address - Fax:678-343-2006
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034447174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000473404BMedicaid
GA07BDCKFMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER