Healthcare Provider Details

I. General information

NPI: 1144255399
Provider Name (Legal Business Name): JOANN DONALDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SWANSON RD
TYRONE GA
30290-6900
US

IV. Provider business mailing address

510 SWANSON RD
TYRONE GA
30290-6900
US

V. Phone/Fax

Practice location:
  • Phone: 770-908-3449
  • Fax: 770-964-5260
Mailing address:
  • Phone: 770-908-3449
  • Fax: 770-964-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number032720
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: