Healthcare Provider Details

I. General information

NPI: 1760401095
Provider Name (Legal Business Name): GEORGIA KAY MCDONALD D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 VENDOME PL
NEW ORLEANS LA
70125-2740
US

IV. Provider business mailing address

4201 VENDOME PL
NEW ORLEANS LA
70125-2740
US

V. Phone/Fax

Practice location:
  • Phone: 504-858-7829
  • Fax:
Mailing address:
  • Phone: 504-858-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4203
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: