Basic Information
| Provider Information | |||||||||
| NPI: | 1235105420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14417 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314161417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123546614 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2323 MAIN ST., STE 202 | ||||||||
| Address2: | |||||||||
| City: | HILTON HEAD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299266607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436823583 | ||||||||
| FaxNumber: | 8436823597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS9578 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 83768 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 16620 | 01 | FL | FL BLUE - INDIVIDUAL | OTHER | GR172A | 01 | FL | MEDICARE - GROUP | OTHER | 16620U | 01 | FL | MEDICARE - INDIVIDUAL | OTHER | 2731240-00 | 05 | FL | MEDICAID | 0098365-00 | 01 | FL | FL MEDICAID - GROUP | OTHER | P00901341 | 01 | FL | RR MEDICARE | OTHER |