Provider Demographics
NPI:1487999587
Name:ASSAF, DANIEL HASAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HASAN
Last Name:ASSAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HASAN
Other - Middle Name:MOHAMAD
Other - Last Name:ASSAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:805 SANDY PLAINS ROAD
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-228-2721
Practice Address - Fax:678-688-2405
Is Sole Proprietor?:No
Enumeration Date:2012-12-01
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP618207ZP0102X
GA82288207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology