Provider Demographics
NPI:1982491874
Name:DANIELS, CHARLES III
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:DANIELS
Suffix:III
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 MENEREY LN APT 107
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-9018
Mailing Address - Country:US
Mailing Address - Phone:216-280-0820
Mailing Address - Fax:
Practice Address - Street 1:5711 MENEREY LN APT 107
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-9018
Practice Address - Country:US
Practice Address - Phone:216-280-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSK771639172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver