Healthcare Provider Details

I. General information

NPI: 1649389594
Provider Name (Legal Business Name): PATRICE NOREEN DONAHUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 MEDICAL CENTER PKWY
SELMA AL
36701-6780
US

IV. Provider business mailing address

417 MEDICAL CENTER PKWY
SELMA AL
36701-7703
US

V. Phone/Fax

Practice location:
  • Phone: 334-875-2100
  • Fax:
Mailing address:
  • Phone: 334-418-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00017793
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: