Provider Demographics
NPI:1699894873
Name:CHAN, DANIEL S (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:CHAN
Suffix:
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 1:840 PINE ST
Mailing Address - Street 2:STE 500
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2100
Mailing Address - Country:US
Mailing Address - Phone:478-633-8682
Mailing Address - Fax:478-633-8698
Practice Address - Street 1:840 PINE ST
Practice Address - Street 2:STE 500
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2100
Practice Address - Country:US
Practice Address - Phone:478-633-8682
Practice Address - Fax:478-633-8698
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072517207XX0801X, 207XX0801X
FLME103680207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000847900Medicaid
FL9103325OtherAETNA
GA003148383AMedicaid
FL1122598OtherCIGNA
FL326803OtherAVMED
FL145CJOtherBC/BS
FL000847900Medicaid