Basic Information
| Provider Information | |||||||||
| NPI: | 1568515245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCELHANNON | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 SOUTHCREST DR | ||||||||
| Address2: | SUITE # 250 | ||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302816118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709969945 | ||||||||
| FaxNumber: | 7709967355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 SOUTHCREST DR | ||||||||
| Address2: | SUITE # 250 | ||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302816118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709969945 | ||||||||
| FaxNumber: | 7709967355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 03/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 003733 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 100002270A | 05 | GA | MEDICAID | 970028667 | 01 | GA | MEDICARE RAILROAD | OTHER | 003489 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER |