Provider Demographics
NPI:1235104464
Name:DANIELS, DAMON (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ATRIUM WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6301
Mailing Address - Country:US
Mailing Address - Phone:803-865-9655
Mailing Address - Fax:803-865-9653
Practice Address - Street 1:110 ATRIUM WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6301
Practice Address - Country:US
Practice Address - Phone:803-865-9655
Practice Address - Fax:803-865-9653
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC218231Medicaid
SCH58379Medicare UPIN
SC218231Medicaid