Provider Demographics
NPI:1235105420
Name:DANIELS, JOHN THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
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:PO BOX 14417
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1417
Mailing Address - Country:US
Mailing Address - Phone:912-354-6614
Mailing Address - Fax:
Practice Address - Street 1:2323 MAIN ST., STE 202
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-6607
Practice Address - Country:US
Practice Address - Phone:843-682-3583
Practice Address - Fax:843-682-3597
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9578207R00000X, 207RP1001X
SC83768207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16620OtherFL BLUE - INDIVIDUAL
FLGR172AOtherMEDICARE - GROUP
FL16620UOtherMEDICARE - INDIVIDUAL
FL2731240-00Medicaid
FL0098365-00OtherFL MEDICAID - GROUP
FLP00901341OtherRR MEDICARE
FL16620OtherFL BLUE - INDIVIDUAL