Healthcare Provider Details

I. General information

NPI: 1306825450
Provider Name (Legal Business Name): DEBORAH F. MCDONALD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N ASHLEY ST
VALDOSTA GA
31602-1709
US

IV. Provider business mailing address

3001 N ASHLEY ST
VALDOSTA GA
31602-1709
US

V. Phone/Fax

Practice location:
  • Phone: 229-247-8484
  • Fax: 229-247-7996
Mailing address:
  • Phone: 229-247-8484
  • Fax: 229-247-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001047
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: