Healthcare Provider Details

I. General information

NPI: 1851769004
Provider Name (Legal Business Name): DEBORAH F MCDONALD OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
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 Number
License Number State

VIII. Authorized Official

Name: DEBORAH F. MCDONALD
Title or Position: OD/OWNER
Credential: OD/OWNER
Phone: 229-247-8484