Provider Demographics
NPI:1477685063
Name:DANIELS, WILLIAM W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:DANIELS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3110
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-3110
Mailing Address - Country:US
Mailing Address - Phone:912-634-1050
Mailing Address - Fax:912-634-9111
Practice Address - Street 1:2927 DEMERE RD
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1620
Practice Address - Country:US
Practice Address - Phone:912-634-1050
Practice Address - Fax:912-634-9111
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0525512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND71840Medicare UPIN