Provider Demographics
NPI:1144233735
Name:CADDELL, TITUS DANIEL SR (MD)
Entity Type:Individual
Prefix:MR
First Name:TITUS
Middle Name:DANIEL
Last Name:CADDELL
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:588 OLD MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2814
Mailing Address - Country:US
Mailing Address - Phone:843-376-5595
Mailing Address - Fax:843-797-7432
Practice Address - Street 1:588 OLD MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2814
Practice Address - Country:US
Practice Address - Phone:843-376-5595
Practice Address - Fax:843-797-7432
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC12475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D908282976Medicare UPIN