Provider Demographics
NPI:1568515245
Name:MCELHANNON, DANIEL CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHRISTOPHER
Last Name:MCELHANNON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SOUTHCREST DR
Mailing Address - Street 2:SUITE # 250
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6118
Mailing Address - Country:US
Mailing Address - Phone:770-996-9945
Mailing Address - Fax:770-996-7355
Practice Address - Street 1:1035 SOUTHCREST DR
Practice Address - Street 2:SUITE # 250
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6118
Practice Address - Country:US
Practice Address - Phone:770-996-9945
Practice Address - Fax:770-996-7355
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003733363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002270AMedicaid
GA970028667OtherMEDICARE RAILROAD
GA003489OtherBLUE CROSS BLUE SHIELD
GA97WCCZNMedicare ID - Type Unspecified
GA970028667OtherMEDICARE RAILROAD