Healthcare Provider Details

I. General information

NPI: 1962072017
Provider Name (Legal Business Name): DONICIA RAILEY MABO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 GA HIGHWAY 96 STE D3-D5
KATHLEEN GA
31047-2111
US

IV. Provider business mailing address

1114 GA HIGHWAY 96 STE D3-D5
KATHLEEN GA
31047-2111
US

V. Phone/Fax

Practice location:
  • Phone: 478-910-1090
  • Fax: 478-910-1091
Mailing address:
  • Phone: 478-910-1090
  • Fax: 478-910-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP242109
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: