Healthcare Provider Details

I. General information

NPI: 1770880486
Provider Name (Legal Business Name): JAMES STUART MCDANIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 PILOT BOY
WADMALAW ISLAND SC
29487-6993
US

IV. Provider business mailing address

1140 PILOT BOY RD.
WADMALAW ISLAND SC
29487
US

V. Phone/Fax

Practice location:
  • Phone: 843-559-7267
  • Fax:
Mailing address:
  • Phone: 843-559-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number13063
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: