Provider Demographics
NPI:1699729004
Name:JANS, DANIEL ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ROBERT
Last Name:JANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-3223
Mailing Address - Country:US
Mailing Address - Phone:706-896-4673
Mailing Address - Fax:706-896-3992
Practice Address - Street 1:103 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3223
Practice Address - Country:US
Practice Address - Phone:706-896-4673
Practice Address - Fax:706-896-3992
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2484363A00000X
MTMED-PAC-LIC-338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MJ3186637OtherDEA
1699729004Medicare PIN
MT4301193Medicaid
MT94793OtherBC/BS
MTMJ0719320OtherDEA