Healthcare Provider Details

I. General information

NPI: 1528920329
Provider Name (Legal Business Name): WILLIAM CHARLES DANIELL CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PARKWOOD DR
BRUNSWICK GA
31520-4722
US

IV. Provider business mailing address

165 PALMERA LN
BRUNSWICK GA
31525-3065
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7000
  • Fax:
Mailing address:
  • Phone: 912-996-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberDANI-GPXN3H
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: