Healthcare Provider Details

I. General information

NPI: 1619076551
Provider Name (Legal Business Name): YVONNE C. DONALDSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 B CEDAR ST
METTER GA
30439-3043
US

IV. Provider business mailing address

PO BOX 597
METTER GA
30439-0597
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-1215
  • Fax: 912-685-1216
Mailing address:
  • Phone: 912-685-1215
  • Fax: 912-685-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN047984
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: