Healthcare Provider Details

I. General information

NPI: 1750320438
Provider Name (Legal Business Name): DANIEL W MCDONALD III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 HORIZON PARK DR STE A
SUWANEE GA
30024-7256
US

IV. Provider business mailing address

2910 HORIZON PARK DR STE A
SUWANEE GA
30024-7256
US

V. Phone/Fax

Practice location:
  • Phone: 770-271-8989
  • Fax: 770-932-8297
Mailing address:
  • Phone: 770-271-8989
  • Fax: 770-932-8297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY003464
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: