Provider Demographics
NPI:1740704055
Name:DANIELS, JULIE SHELTON (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:SHELTON
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NP
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-7779
Practice Address - Street 1:840 W FLOYD BAKER BLVD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1845
Practice Address - Country:US
Practice Address - Phone:864-489-3300
Practice Address - Fax:864-488-3744
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210762163W00000X
SC21326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCB5465121OtherMEDICARE PIN
SCNP4766Medicaid
SCSCB5466121OtherMEDICARE PIN
SCSCB546J577OtherMEDICARE PIN
SCSCB5466067OtherMEDICARE PIN
SCSCB5465019OtherMEDICARE PIN