Provider Demographics
NPI:1326117532
Name:BATES, DANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:BATES
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 1:6489 GARNERS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1639
Mailing Address - Country:US
Mailing Address - Phone:803-776-4000
Mailing Address - Fax:803-647-5751
Practice Address - Street 1:6489 GARNERS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1639
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:803-647-5751
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC063852Medicaid
SC063852Medicaid
SCF51580Medicare UPIN