Provider Demographics
NPI:1912359100
Name:DANIEL, BRIAN HEATH
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:HEATH
Last Name:DANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MARIARDEN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-6254
Mailing Address - Country:US
Mailing Address - Phone:256-825-7871
Mailing Address - Fax:256-825-5742
Practice Address - Street 1:301 MARIARDEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-6254
Practice Address - Country:US
Practice Address - Phone:256-825-7871
Practice Address - Fax:256-825-5742
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily