Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 005759 | GA |
NPI | 1639214208 |
---|---|
Provider Name | Mr. James Kevin Donohue |
First Address | Cumming, GA 30040-5704 |
Second Address | Cumming, GA 30040-5704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 17/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2193566 | AETNA (01) | DE |
5381641 | AETNA (01) | GA |
U69556 | (02) | GA |