Provider Demographics
NPI:1225078561
Name:DANIELS, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:DANIELS
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 1:4230 HARDING RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-383-8009
Mailing Address - Fax:615-942-7183
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-383-8009
Practice Address - Fax:615-942-7183
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN012611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12611OtherCENTERCARE
TN1507995Medicaid
TN3164296OtherBLUE CROSS OF TN
KY64779820Medicaid
TN633798OtherUSA-MCO
TN0323386OtherCIGNA
TN110219038OtherMEDICARE RR
TN0323386OtherCIGNA
TN3180214Medicare PIN