Provider Demographics
NPI:1528077310
Name:DANIELS, ROYDEN EUGENE III (MD)
Entity type:Individual
Prefix:DR
First Name:ROYDEN
Middle Name:EUGENE
Last Name:DANIELS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725231
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-2231
Mailing Address - Country:US
Mailing Address - Phone:770-815-5927
Mailing Address - Fax:
Practice Address - Street 1:60 PEACHTREE PARK DR NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1304
Practice Address - Country:US
Practice Address - Phone:770-815-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0555582085B0100X, 2085D0003X, 2085N0700X, 2085P0229X, 2085U0001X, 2085R0202X
SCME223122085B0100X, 2085P0229X, 2085N0904X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10039347OtherAMERIGROUP GHF
GAP00400293OtherRAILROAD MEDICARE
SC223127Medicaid
1923656OtherFIRST HEALTH
300126257OtherMEDICARE RR
SCH33355Medicare UPIN
GA10039347OtherAMERIGROUP GHF
SCH333551709Medicare ID - Type Unspecified