Provider Demographics
NPI:1588619662
Name:MEADOWS, DANIEL THOMAS JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
Last Name:MEADOWS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1921
Mailing Address - Country:US
Mailing Address - Phone:256-739-0801
Mailing Address - Fax:256-739-0027
Practice Address - Street 1:101 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3511
Practice Address - Country:US
Practice Address - Phone:256-739-4910
Practice Address - Fax:256-739-9455
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL102232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL118357Medicaid
AL89307OtherBCBS
AL89308OtherBCBS
AL1235365255Medicaid
E869Medicare PIN