Provider Demographics
NPI:1184858086
Name:DANIELS, COREY GARRETT (DO)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:GARRETT
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 DODDS AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3911
Mailing Address - Country:US
Mailing Address - Phone:866-730-5619
Mailing Address - Fax:423-698-3622
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-664-9731
Practice Address - Fax:716-664-9160
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN42552085R0202X
NY2803462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program