Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 032720 | GA |
NPI | 1144255399 |
---|---|
Provider Name | Dr. Joann Donaldson |
First Address | Tyrone, GA 30290-6900 |
Second Address | Tyrone, GA 30290-6900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D45611 | (02) | GA |