Provider Demographics
NPI:1457333940
Name:DANIELS, ROBERT KEITH JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEITH
Last Name:DANIELS
Suffix:JR
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:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1038
Mailing Address - Country:US
Mailing Address - Phone:706-649-6600
Mailing Address - Fax:706-649-6614
Practice Address - Street 1:920 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1524
Practice Address - Country:US
Practice Address - Phone:706-649-6600
Practice Address - Fax:706-649-6614
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00019461208600000X
AL00019461208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009903545Medicaid
GA000689939BMedicaid
GAG18052Medicare UPIN
GA02BBGFVMedicare PIN
AL46317Medicare PIN