1770569048 NPI number — DR. JOSHUA ADAM DONIS MD

Table of content: DR. JOSHUA ADAM DONIS MD (NPI 1770569048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770569048 NPI number — DR. JOSHUA ADAM DONIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONIS
Provider First Name:
JOSHUA
Provider Middle Name:
ADAM
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:
1770569048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 W GORDON ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMASTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30286-3480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-646-5712
Provider Business Mailing Address Fax Number:
706-647-5111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 W GORDON ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMASTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30286-3480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-646-5712
Provider Business Practice Location Address Fax Number:
706-647-5111
Provider Enumeration Date:
12/19/2005

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: 207RC0000X , with the licence number:  2018004429 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 89883 , 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: 2291730 08 . This is a "UNITED HEALTHCAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 504P42 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 210657 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7317425 . This is a "AETNA (NON-HMO)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2804094 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com