Healthcare Provider Details

I. General information

NPI: 1588093587
Provider Name (Legal Business Name): DONALD PIESTRAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 LAFAYETTE PKWY
LAGRANGE GA
30241-2572
US

IV. Provider business mailing address

1698 VERNON RD
LAGRANGE GA
30240-4100
US

V. Phone/Fax

Practice location:
  • Phone: 706-298-4937
  • Fax: 706-298-4926
Mailing address:
  • Phone: 706-298-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: