Healthcare Provider Details

I. General information

NPI: 1275534190
Provider Name (Legal Business Name): MYRON TODD MCDONALD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W FRANKLIN ST
SYLVESTER GA
31791-1900
US

IV. Provider business mailing address

2805 STONEWATER DR
ALBANY GA
31721-6226
US

V. Phone/Fax

Practice location:
  • Phone: 229-776-3500
  • Fax:
Mailing address:
  • Phone: 229-883-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP115747
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: