Provider Demographics
NPI:1275642464
Name:MCDANIEL, WILLIAM FRANKLIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FRANKLIN
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-4267
Mailing Address - Country:US
Mailing Address - Phone:478-457-7127
Mailing Address - Fax:478-968-0698
Practice Address - Street 1:172 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4267
Practice Address - Country:US
Practice Address - Phone:478-457-7127
Practice Address - Fax:478-968-0698
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2182103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000846843BMedicaid
GA000846843BMedicaid