Provider Demographics
NPI:1174676829
Name:MCDEVITT, DANIEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:THOMAS
Last Name:MCDEVITT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1035 SOUTHCREST DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6118
Mailing Address - Country:US
Mailing Address - Phone:770-996-9945
Mailing Address - Fax:770-996-7355
Practice Address - Street 1:1035 SOUTHCREST DR
Practice Address - Street 2:SUITE 250
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6118
Practice Address - Country:US
Practice Address - Phone:770-996-9945
Practice Address - Fax:770-996-7355
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-03-17
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Provider Licenses
StateLicense IDTaxonomies
GA0370252086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1861090-012OtherCIGNA
GA581800973OtherUNITED HEALTHCARE
GA770001325OtherMEDICARE RAILROAD
GA281529OtherWELLCARE CHOICE PLAN
GA000546521CMedicaid
GA0486348OtherAETNA
GA52451306002OtherBLUE CROSS BLUE SHIELD
GAF05885Medicare UPIN
GA02BDDZJMedicare ID - Type Unspecified