Provider Demographics
NPI:1184622490
Name:MAGILL, DANIEL H III (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:MAGILL
Suffix:III
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:PO BOX 5860
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-5860
Mailing Address - Country:US
Mailing Address - Phone:706-546-8510
Mailing Address - Fax:706-546-1147
Practice Address - Street 1:700 OGLETHORPE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2221
Practice Address - Country:US
Practice Address - Phone:706-546-8510
Practice Address - Fax:706-546-1147
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014287207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1265571OtherUNITED HEALTHCARE
GA00115882AMedicaid
GA060014202OtherRAILROAD MEDICARE
GA5033001OtherAETNA
GA00711OtherBLUE SHIELD
GA1265571OtherUNITED HEALTHCARE