Healthcare Provider Details

I. General information

NPI: 1275561318
Provider Name (Legal Business Name): PATRICIA COLQUHOUN DONALDSON I RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

3052 CLAIRMONT RD NE APT. C
ATLANTA GA
30329-1619
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-728-5008
Mailing address:
  • Phone: 404-321-6111
  • Fax: 404-728-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number021777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: