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General NPI Number Information
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NPI Number | 1689536252
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Entity Type | Individual
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Provider Name | DEMETRIA ANISE MCDONALD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 512 MORSE AVE
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City | MONTEZUMA
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State | GA
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Zip | 31063-1252
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Country | US
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Telephone | 706-496-7691
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Fax |
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Provider Business Mailing Address
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Address Line | 500 NORTHSIDE XING STE A
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City | MACON
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State | GA
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Zip | 31210-2377
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Country | US
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Telephone | 185-583-2672
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State | GA
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