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General NPI Number Information
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NPI Number | 1104931906
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Entity Type | Individual
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Provider Name | DONNA G SOUTHERS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 324 OAKVALE RD STE 12
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City | PRINCETON
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State | WV
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Zip | 24740-3829
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Country | US
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Telephone | 681-282-5576
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Fax | 304-431-7112
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Provider Business Mailing Address
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Address Line | 324 OAKVALE RD
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City | PRINCETON
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State | WV
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Zip | 24740-3829
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Country | US
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Telephone | 681-282-5576
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Fax | 681-282-5583
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 292
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License Number State | WV
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