Provider Demographics
NPI:1902195241
Name:MCDANIEL, GEORGE MARK (HIS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MARK
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3187
Mailing Address - Country:US
Mailing Address - Phone:828-258-9742
Mailing Address - Fax:
Practice Address - Street 1:1550 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3187
Practice Address - Country:US
Practice Address - Phone:828-258-9742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1167237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC615416700OtherUS DEPARTMENT OF LABOR OWCP