Healthcare Provider Details

I. General information

NPI: 1932029741
Provider Name (Legal Business Name): ELLEN C MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 MAIN ST STE D
PERRY GA
31069-4313
US

IV. Provider business mailing address

1013 MAIN ST STE D
PERRY GA
31069-4313
US

V. Phone/Fax

Practice location:
  • Phone: 478-224-1440
  • Fax: 478-224-1441
Mailing address:
  • Phone: 478-224-1440
  • Fax: 478-224-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: