Healthcare Provider Details

I. General information

NPI: 1639214208
Provider Name (Legal Business Name): JAMES KEVIN DONOHUE P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6094 ODELL ST
CUMMING GA
30040-5704
US

IV. Provider business mailing address

6094 ODELL ST
CUMMING GA
30040-5704
US

V. Phone/Fax

Practice location:
  • Phone: 770-846-5628
  • Fax:
Mailing address:
  • Phone: 770-846-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number005759
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: