Provider Demographics
NPI:1033578943
Name:DAUGHTRY, DANIELLE (CNA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 HOPKINS ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-3041
Mailing Address - Country:US
Mailing Address - Phone:706-373-3501
Mailing Address - Fax:
Practice Address - Street 1:731 HOPKINS ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-3041
Practice Address - Country:US
Practice Address - Phone:706-373-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-R-1461251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health