Provider Demographics
NPI:1437243334
Name:MCDANIEL, WILLIAM JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 CABIN CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2528
Mailing Address - Country:US
Mailing Address - Phone:404-386-3147
Mailing Address - Fax:
Practice Address - Street 1:187 CHASTAIN RD NW STE 200
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3010
Practice Address - Country:US
Practice Address - Phone:770-422-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA312822083B0002X
GA031282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF28799Medicare UPIN