MEDICARE: DR. ROBERT J DANIELL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	000426	GA

General Provider Information

NPI Number	:	1346230208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J DANIELL PH.D.

Provider Business Mailing Address
First Line	:	1810 HOMESTEAD AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3136
Country	:	US
Telephone Number	:	404-876-1788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 HARDEE AVE SW
Second Line	:
City	:	FT MCPHERSON
State	:	GA
Zip	:	30330-1062
Country	:	US
Telephone Number	:	404-464-3562
Fax Number	:	404-464-4764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	03/30/2011

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