Provider Demographics
NPI:1942033857
Name:RILES, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:RILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 OLD PERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31057-9740
Mailing Address - Country:US
Mailing Address - Phone:218-626-5299
Mailing Address - Fax:
Practice Address - Street 1:206 OLD PERRY RD
Practice Address - Street 2:
Practice Address - City:MARSHALLVILLE
Practice Address - State:GA
Practice Address - Zip Code:31057-9740
Practice Address - Country:US
Practice Address - Phone:218-626-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator