Provider Demographics
NPI:1275534943
Name:MCDANIEL, JAMES EDMONDS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDMONDS
Last Name:MCDANIEL
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 1:601 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7698
Mailing Address - Country:US
Mailing Address - Phone:678-376-4242
Mailing Address - Fax:678-376-4245
Practice Address - Street 1:601 PROFESSIONAL DR
Practice Address - Street 2:SUITE 160
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7698
Practice Address - Country:US
Practice Address - Phone:678-376-4242
Practice Address - Fax:678-376-4245
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0217462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00310373AMedicaid
GA00310373AMedicaid