Provider Demographics
NPI:1750320438
Name:MCDONALD, DANIEL W III (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:MCDONALD
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 HORIZON PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7256
Mailing Address - Country:US
Mailing Address - Phone:770-271-8989
Mailing Address - Fax:770-932-8297
Practice Address - Street 1:2910 HORIZON PARK DR STE A
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7256
Practice Address - Country:US
Practice Address - Phone:770-271-8989
Practice Address - Fax:770-932-8297
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003464103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0515016Medicaid
AL051501699OtherBC BS OF AL
AL0515016Medicaid
AL0515016Medicaid