Healthcare Provider Details

I. General information

NPI: 1255339958
Provider Name (Legal Business Name): DANIEL G MCDONOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

3007 MEMORIAL PKWY SW SUITE C
HUNTSVILLE AL
35801-5393
US

IV. Provider business mailing address

3007 MEMORIAL PKWY SW SUITE C
HUNTSVILLE AL
35801-5393
US

V. Phone/Fax

Practice location:
  • Phone: 256-799-2500
  • Fax: 256-799-2501
Mailing address:
  • Phone: 256-799-2500
  • Fax: 256-799-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25210
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD25210
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: