Provider Demographics
NPI:1083667877
Name:HORNER, DONALD STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STANLEY
Last Name:HORNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BILLINGSLEY RD
Mailing Address - Street 2:#201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-366-8400
Mailing Address - Fax:704-366-8499
Practice Address - Street 1:330 BILLINGSLEY RD
Practice Address - Street 2:#201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-366-8400
Practice Address - Fax:704-366-8499
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26269207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8943772Medicaid
C81429Medicare UPIN