Healthcare Provider Details

I. General information

NPI: 1962794016
Provider Name (Legal Business Name): DONALD J HALKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 FLORENCE RD
SAVANNAH TN
38372-3451
US

IV. Provider business mailing address

PO BOX 655
SAVANNAH TN
38372-0655
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-2300
  • Fax: 731-925-3506
Mailing address:
  • Phone: 731-925-2300
  • Fax: 731-925-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102203774
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT014085
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2889
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: