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General NPI Number Information
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NPI Number | 1992873517
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Entity Type | Individual
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Provider Name | REBECCA ABIGAIL DONDANVILLE ATC, EDD
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 1021 CENTRAL AVE
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City | DEMOREST
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State | GA
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Zip | 30535
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Country | US
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Telephone | 706-778-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 160 MALLARD POND CIR
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City | ALTO
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State | GA
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Zip | 30510-3033
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Country | US
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Telephone | 704-221-1311
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0663
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002431
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL 566
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License Number State | FL
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