Healthcare Provider Details

I. General information

NPI: 1518997014
Provider Name (Legal Business Name): MARK A. MCDANIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 INDUSTRIAL PKWY STE B
SARALAND AL
36571-3746
US

IV. Provider business mailing address

960 INDUSTRIAL PKWY STE B
SARALAND AL
36571-3746
US

V. Phone/Fax

Practice location:
  • Phone: 251-414-5900
  • Fax: 251-445-8859
Mailing address:
  • Phone: 251-414-5900
  • Fax: 251-445-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12136
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: