| Doctor Name: | MR. DANIEL WILSON KREVDO |
| NPI Number: | 1427255769 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPA |
| License Number: | JX39313 |
| Business Practice Address: | 901 Griffin Ave Eastman, GA - 310236720 |
| Business Phone Number: | 4784484048 |
| Business Fax Number: | 4783749797 |
| Mailing Address: | 621 North Avenue, Ne, Suite C-30 ATLANTA |
| State: | GA |
| Postal Code: | 30308 |
| Phone Number: | 6789046820 |
| Fax Number: | 6789046824 |
| NPI Enumeration Date: | 06/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471C3401X |
| License Number: | JX39313 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | FL |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Computed Tomography |
| Taxonomy Definition: | |