Provider Demographics
NPI:1447244348
Name:STANLEY, J DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:DANIEL
Last Name:STANLEY
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 1:979 E 3RD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-267-0466
Mailing Address - Fax:423-778-8168
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:STE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-267-0466
Practice Address - Fax:423-778-8168
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25268208C00000X, 208C00000X
TNMD25268208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002558Medicaid
TN240006287OtherRR MEDICARE
62165877450OtherJDH
4882235 002OtherCIGNA
3121091OtherBCBS OF TN
AL009905580Medicaid
GA00814008AMedicaid
1440000OtherUHC
3121091OtherBCBS OF TN
AL009905580Medicaid
3082414Medicare ID - Type Unspecified
3082415Medicare ID - Type Unspecified
TN3082412Medicaid