Provider Demographics
NPI:1447679808
Name:DANIEL, DEEPU (DO)
Entity type:Individual
Prefix:
First Name:DEEPU
Middle Name:
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 PROFESSIONAL DR STE 290
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3347
Mailing Address - Country:US
Mailing Address - Phone:770-417-8170
Mailing Address - Fax:855-530-3640
Practice Address - Street 1:575 PROFESSIONAL DR STE 290
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3347
Practice Address - Country:US
Practice Address - Phone:770-417-8170
Practice Address - Fax:855-530-3640
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73745208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist