Healthcare Provider Details

I. General information

NPI: 1407058027
Provider Name (Legal Business Name): DONNIE P. DUNAGAN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 CENTRAL AVE
AUGUSTA GA
30904-4128
US

IV. Provider business mailing address

2042 CENTRAL AVE
AUGUSTA GA
30904-4128
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-1104
  • Fax: 706-736-8465
Mailing address:
  • Phone: 706-733-1104
  • Fax: 706-736-8465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number14609
License Number StateGA

VIII. Authorized Official

Name: DONNIE P DUNAGAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 706-733-1104