=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427708916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHNNIE ELIZABETH MCDONALD MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2022
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 451 MURTHA DR
-----------------------------------------------------
City | WAYNESBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15370-7010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-988-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5042 W CANYON DR
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26508-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-550-2481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 33377
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD489562
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------