Healthcare Provider Details

I. General information

NPI: 1003139643
Provider Name (Legal Business Name): DONNA EARNSHAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 WEAVER RD W
MOUNT VERNON AL
36560-7406
US

IV. Provider business mailing address

266 WEAVER RD W
MOUNT VERNON AL
36560-7406
US

V. Phone/Fax

Practice location:
  • Phone: 251-829-6474
  • Fax:
Mailing address:
  • Phone: 251-829-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17235
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: