MEDICARE: DR. DONALD GABRIEL POLK D.O.

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	207Q00000X	Family Medicine Physician	DO1538	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942294863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD GABRIEL POLK D.O.

Provider Business Mailing Address
First Line	:	2717 EAST OAKLAND AVENUE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1843
Country	:	US
Telephone Number	:	423-926-2358
Fax Number	:	423-926-2680

Provider Business Practice Location Address
First Line	:	103 JV MANGUBAT DR
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-2440
Country	:	US
Telephone Number	:	931-762-9418
Fax Number	:	931-722-9081

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	01/10/2024

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