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NPI Code Detail

MEDICARE: JOSE M DONATIEN MD

MEDICARE: JOSE M DONATIEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician88976GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
214S65OTHERFLFLORIDA BLUE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841511797
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE M DONATIEN MD
Provider Business Mailing Address
First Line : PO BOX 740015
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0015
Country : US
Telephone Number : 312-733-9730
Fax Number : 773-866-8014
Provider Business Practice Location Address
First Line : 1825 ROCKBRIDGE RD STE 15B
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30087-3306
Country : US
Telephone Number : 470-444-3134
Fax Number : 470-276-4370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2010
Last Update Date : 11/18/2024

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Directions to “ JOSE M DONATIEN MD” Practice Location

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