Provider Demographics
NPI:1972763480
Name:DANIELS, BRANDON LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LLOYD
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16639 TURTLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8425
Mailing Address - Country:US
Mailing Address - Phone:803-426-6007
Mailing Address - Fax:
Practice Address - Street 1:953 DOUGHERTY RD
Practice Address - Street 2:UNIT B
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-6508
Practice Address - Country:US
Practice Address - Phone:803-226-0526
Practice Address - Fax:803-226-0527
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30852207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC308526Medicaid