Provider Demographics
NPI:1063608131
Name:WILLIAM W. DANIELS, JR., M.D., PC
Entity type:Organization
Organization Name:WILLIAM W. DANIELS, JR., M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:912-634-1050
Mailing Address - Street 1:PO BOX 3110
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-3110
Mailing Address - Country:US
Mailing Address - Phone:912-634-1050
Mailing Address - Fax:912-634-9111
Practice Address - Street 1:2927 DEMERE RD
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1620
Practice Address - Country:US
Practice Address - Phone:912-634-1050
Practice Address - Fax:912-634-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0525512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND71840Medicare UPIN