Provider Demographics
NPI:1265025456
Name:DANIELS, GHANDI S
Entity Type:Individual
Prefix:MRS
First Name:GHANDI
Middle Name:S
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 MOBILE HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-4027
Mailing Address - Country:US
Mailing Address - Phone:334-293-6502
Mailing Address - Fax:334-293-6474
Practice Address - Street 1:3060 MOBILE HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36108-4027
Practice Address - Country:US
Practice Address - Phone:334-293-6502
Practice Address - Fax:334-293-6474
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator