Provider Demographics
NPI:1093085524
Name:DONALSON, DENA CUTTS
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:CUTTS
Last Name:DONALSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 RIVER OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817
Mailing Address - Country:US
Mailing Address - Phone:229-246-8378
Mailing Address - Fax:
Practice Address - Street 1:215 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-1030
Practice Address - Country:US
Practice Address - Phone:229-246-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021424183500000X
FLPS32505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist