Healthcare Provider Details

I. General information

NPI: 1205759362
Provider Name (Legal Business Name): ASA CHARLES DANIELS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 ARMOUR DR NE STE E
ATLANTA GA
30324-3975
US

IV. Provider business mailing address

545 E PONCE DE LEON AVE
DECATUR GA
30030-1941
US

V. Phone/Fax

Practice location:
  • Phone: 404-685-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: