Healthcare Provider Details

I. General information

NPI: 1952579039
Provider Name (Legal Business Name): KRISTEN KATHRYNE DONALDSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 POWELL ST SUITE 900
EMERYVILLE CA
94608-1826
US

IV. Provider business mailing address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

V. Phone/Fax

Practice location:
  • Phone: 510-350-2600
  • Fax:
Mailing address:
  • Phone: 404-501-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005250
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: