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General NPI Number Information
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NPI Number | 1528628773
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Entity Type | Organization
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Legal Business Name | DONOHOO PRIMARY CARE LLC
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 5160 STATE ROUTE 125
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City | GEORGETOWN
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State | OH
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Zip | 45121-9518
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Country | US
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Telephone | 937-213-1092
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Fax |
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Provider Business Mailing Address
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Address Line | 7407 FOX RUN RD
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City | GEORGETOWN
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State | OH
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Zip | 45121-8414
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Country | US
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Telephone | 937-213-1092
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | VENITA C MILBURN
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Credential | BS, CMM, RMA, SWA
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Telephone | 513-304-2523
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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 |
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License Number State |
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