Provider Demographics
NPI:1215491691
Name:PETERS, DANIELS EARL
Entity type:Individual
Prefix:
First Name:DANIELS
Middle Name:EARL
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 ASBURY SQ
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2421
Mailing Address - Country:US
Mailing Address - Phone:239-321-9007
Mailing Address - Fax:
Practice Address - Street 1:3114 ASBURY SQ
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2421
Practice Address - Country:US
Practice Address - Phone:239-321-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other