Healthcare Provider Details

I. General information

NPI: 1336104710
Provider Name (Legal Business Name): DANIEL J MCMAHON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 FRESHFIELDS DR STE J101
JOHNS ISLAND SC
29455-5443
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-768-4800
  • Fax: 843-768-1124
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1301
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: