Provider Demographics
NPI:1427255769
Name:KREVDO, DANIEL WILSON (RPA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WILSON
Last Name:KREVDO
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:621 NORTH AVENUE, NE
Mailing Address - Street 2:SUITE C-30
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:678-904-6820
Mailing Address - Fax:678-904-6824
Practice Address - Street 1:901 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6720
Practice Address - Country:US
Practice Address - Phone:478-448-4048
Practice Address - Fax:478-374-9797
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLJX393132471C3401X, 2471C3402X, 2471V0106X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical