Healthcare Provider Details

I. General information

NPI: 1952440968
Provider Name (Legal Business Name): DONOVAN ROSS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S STERLING ST
MORGANTON NC
28655-4044
US

IV. Provider business mailing address

2201 S STERLING ST
MORGANTON NC
28655-4044
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-6403
  • Fax: 828-580-6409
Mailing address:
  • Phone: 828-580-6403
  • Fax: 828-580-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2005-00364
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2005-00364
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: