Healthcare Provider Details

I. General information

NPI: 1003818741
Provider Name (Legal Business Name): NORMAN L DONATI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MACON ST
MACON GA
31210-6563
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 478-200-6970
  • Fax: 478-216-5976
Mailing address:
  • Phone:
  • Fax: 706-494-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number041777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: