Provider Demographics
NPI:1497982656
Name:MCDANIEL, LINDA R (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:R
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:690 DALLAS HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1264
Mailing Address - Country:US
Mailing Address - Phone:770-456-3850
Mailing Address - Fax:770-456-3826
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1264
Practice Address - Country:US
Practice Address - Phone:770-456-3850
Practice Address - Fax:770-456-3826
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN191724367A00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant