MEDICARE: WILLIAM CHARLES DANIELL CAA

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	367H00000X	Anesthesiologist Assistant	DANI-GPXN3H	GA

General Provider Information

NPI Number	:	1528920329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM CHARLES DANIELL CAA

Provider Business Mailing Address
First Line	:	165 PALMERA LN
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31525-3065
Country	:	US
Telephone Number	:	912-996-3062
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 PARKWOOD DR
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4722
Country	:	US
Telephone Number	:	912-466-7000
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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