Healthcare Provider Details

I. General information

NPI: 1386460947
Provider Name (Legal Business Name): DANIELLE DONALDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CLIFTON RD NE
ATLANTA GA
30322-4201
US

IV. Provider business mailing address

1520 CLIFTON RD NE
ATLANTA GA
30322-4201
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-7980
  • Fax:
Mailing address:
  • Phone: 404-727-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number333745
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: