Provider Demographics
NPI:1508132747
Name:MCDANIEL, GARY A JR
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:MCDANIEL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MILES PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4538
Mailing Address - Country:US
Mailing Address - Phone:434-429-5169
Mailing Address - Fax:
Practice Address - Street 1:3014 HEDRICK CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1458
Practice Address - Country:US
Practice Address - Phone:434-429-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities