Provider Demographics
NPI:1043215668
Name:ROSENBAUM, DONALD H (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6788
Mailing Address - Country:US
Mailing Address - Phone:478-374-2490
Mailing Address - Fax:478-374-0337
Practice Address - Street 1:1103 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6788
Practice Address - Country:US
Practice Address - Phone:478-374-2490
Practice Address - Fax:478-374-0337
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046562207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000740572JMedicaid
GA000740572JMedicaid