1427099522 NPI number — DR. THOMAS A DONOHUE MD

Table of content: DR. THOMAS A DONOHUE MD (NPI 1427099522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427099522 NPI number — DR. THOMAS A DONOHUE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONOHUE
Provider First Name:
THOMAS
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427099522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31410-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-232-9700
Provider Business Mailing Address Fax Number:
912-232-9701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5356 REYNOLDS ST
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-6016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-819-8187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  27327 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 048889 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000888599L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52820215-011 . This is a "BCBS GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000888599A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000888599D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10058624 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52820215-001 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: G48889 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GPA892 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000888599E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000888599G , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000888599I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000888599C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000888599J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GPA902 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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