Basic Information
| Provider Information | |||||||||
| NPI: | 1184622490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGILL | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5860 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306045860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065468510 | ||||||||
| FaxNumber: | 7065461147 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 OGLETHORPE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065468510 | ||||||||
| FaxNumber: | 7065461147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 014287 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1265571 | 01 | GA | UNITED HEALTHCARE | OTHER | 00115882A | 05 | GA | MEDICAID | 060014202 | 01 | GA | RAILROAD MEDICARE | OTHER | 5033001 | 01 | GA | AETNA | OTHER | 00711 | 01 | GA | BLUE SHIELD | OTHER |