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Daniel Geoffrey Bosso

Family Medicine

Allopathic & Osteopathic Physicians

597 S Enota Dr NE, Gainesville, GA 30501-2545

PECOS Enrollment

This provider is enrolled in PECOS as DANIEL BOSSO.

Based on the most recent information from CMS, provider Daniel Geoffrey Bosso is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1699815225
Provider Type
Individual
Full Name
Bosso, Daniel Geoffrey
Title
Dr.
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
2/6/2007
Last Updated
2/1/2021

Contact Information

Practice Location

597 S Enota Dr NE, Gainesville, GA 30501-2545

(770) 219-8102

(770) 219-7778

Mailing Location

601 S Enota Dr NE, Suite Q, Gainesville, GA 30501-2400

(770) 219-7826

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 066761 Georgia
Code 207P00000X	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 36654 Missouri

Provider Identifiers

ID	Description	Issuer
ID 98641	Description Other	Issuer AR BLUE SHIELD # Missouri
ID 247970015	Description Medicaid	Issuer Unlisted Missouri

Daniel Geoffrey Bosso

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

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Astaphan, Karl

Kordek, Adrianna Shannon

Alias, Sajiv

Jones, Alexander