Provider Demographics
NPI:1447929708
Name:MCDANIEL, STEPHEN LEWIS
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEWIS
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HEATH SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29058-8744
Mailing Address - Country:US
Mailing Address - Phone:803-667-0405
Mailing Address - Fax:
Practice Address - Street 1:229 POPLAR ST
Practice Address - Street 2:
Practice Address - City:HEATH SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29058-8744
Practice Address - Country:US
Practice Address - Phone:803-667-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCA033843171W00000X
171WH0202X
CA033843171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty