1225336613 NPI number — DR. KELLEY DAVIS DASINGER O.D.

Table of content: DR. KELLEY DAVIS DASINGER O.D. (NPI 1225336613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225336613 NPI number — DR. KELLEY DAVIS DASINGER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DASINGER
Provider First Name:
KELLEY
Provider Middle Name:
DAVIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
KELLEY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225336613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5983 HIGHWAY 53 E
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
DAWSONVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30534-9513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-216-6595
Provider Business Mailing Address Fax Number:
706-216-6594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAHLONEGA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30533-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-864-7000
Provider Business Practice Location Address Fax Number:
706-216-6594
Provider Enumeration Date:
03/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT002853 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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