Provider Demographics
NPI:1508002734
Name:T. DANIEL CADDELL
Entity Type:Organization
Organization Name:T. DANIEL CADDELL
Other - Org Name:T. DANIEL CADDELL MD,PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-841-4191
Mailing Address - Street 1:PO OFFICE BOX 1054
Mailing Address - Street 2:907 N MAIN ST
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-1054
Mailing Address - Country:US
Mailing Address - Phone:864-834-4191
Mailing Address - Fax:864-834-1964
Practice Address - Street 1:907 N MAIN ST
Practice Address - Street 2:PO OFFICE BOX 1054
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-1054
Practice Address - Country:US
Practice Address - Phone:864-834-4191
Practice Address - Fax:864-834-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty