Provider Demographics
NPI:1982700878
Name:MCDANIELS, TIJA L (MD)
Entity Type:Individual
Prefix:
First Name:TIJA
Middle Name:L
Last Name:MCDANIELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIJA
Other - Middle Name:L
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:225 VON KARMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD AIR FORCE BASE
Mailing Address - State:TN
Mailing Address - Zip Code:37389
Mailing Address - Country:US
Mailing Address - Phone:931-454-6134
Mailing Address - Fax:
Practice Address - Street 1:225 VON KARMAN ROAD
Practice Address - Street 2:
Practice Address - City:ARNOLD AIR FORCE BASE
Practice Address - State:TN
Practice Address - Zip Code:37389
Practice Address - Country:US
Practice Address - Phone:931-454-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine