Provider Demographics
NPI:1528501269
Name:HAZELWOOD, DANIELA (NP-C)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:HAZELWOOD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4398 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7314
Mailing Address - Country:US
Mailing Address - Phone:678-732-1519
Mailing Address - Fax:404-614-7359
Practice Address - Street 1:4398 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052
Practice Address - Country:US
Practice Address - Phone:678-732-1519
Practice Address - Fax:404-614-7359
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily