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General NPI Number Information
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NPI Number | 1770594095
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Entity Type | Organization
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Legal Business Name | CORDELE INTERNAL MEDICINE
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1008 N 7TH ST
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City | CORDELE
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State | GA
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Zip | 31015-3761
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Country | US
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Telephone | 229-273-4779
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Fax | 229-273-3452
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Provider Business Mailing Address
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Address Line | 1008 N 7TH ST
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City | CORDELE
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State | GA
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Zip | 31015-3761
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Country | US
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Telephone | 229-273-4779
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Fax | 229-273-3452
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER A DONNAN
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Credential | MD
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Telephone | 229-273-4779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | GA
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