MEDICARE: MR. MYRON TODD MCDONALD FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP115747	GA

General Provider Information

NPI Number	:	1275534190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MYRON TODD MCDONALD FNP-C

Provider Business Mailing Address
First Line	:	2805 STONEWATER DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-6226
Country	:	US
Telephone Number	:	229-883-4045
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 W FRANKLIN ST
Second Line	:
City	:	SYLVESTER
State	:	GA
Zip	:	31791-1900
Country	:	US
Telephone Number	:	229-776-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/10/2025

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