Provider Demographics
NPI:1760711162
Name:DANIELS, CHRISTOPHER WAYNE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:DANIELS
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 1:3278 MITCHELL BLVD
Mailing Address - Street 2:23 MEDICAL GROUP
Mailing Address - City:MOODY AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31699
Mailing Address - Country:US
Mailing Address - Phone:229-257-1459
Mailing Address - Fax:229-257-5520
Practice Address - Street 1:23 MEDICAL GROUP
Practice Address - Street 2:3278 MITCHELL BLVD
Practice Address - City:MOODY A F B
Practice Address - State:GA
Practice Address - Zip Code:31699-0001
Practice Address - Country:US
Practice Address - Phone:229-257-1459
Practice Address - Fax:229-257-5520
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant