Healthcare Provider Details

I. General information

NPI: 1093107583
Provider Name (Legal Business Name): JEANA DONAHUE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANA MARIE CHURCH DO

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HERLONG AVE S
ROCK HILL SC
29732-1158
US

IV. Provider business mailing address

222 HERLONG AVE S
ROCK HILL SC
29732-1158
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-1234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-02204
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81740
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3208
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: