Provider Demographics
NPI:1790319366
Name:MCDANIEL, LETITIA ANTIONETTE (MAA)
Entity Type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:ANTIONETTE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MAA
Other - Prefix:MS
Other - First Name:TIA
Other - Middle Name:ANTIONETTE
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAA
Mailing Address - Street 1:10 GLENLAKE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3495
Mailing Address - Country:US
Mailing Address - Phone:678-222-3419
Mailing Address - Fax:678-222-3401
Practice Address - Street 1:10 GLENLAKE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3495
Practice Address - Country:US
Practice Address - Phone:770-572-6757
Practice Address - Fax:678-222-3401
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide