Provider Demographics
NPI:1093734428
Name:MACNEILL, DONALD (PAAA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MACNEILL
Suffix:
Gender:M
Credentials:PAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-351-1754
Mailing Address - Fax:404-351-7121
Practice Address - Street 1:1640 AIRPORT RD NW
Practice Address - Street 2:STE 110
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7038
Practice Address - Country:US
Practice Address - Phone:678-202-2074
Practice Address - Fax:770-590-1442
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000390277Medicaid
GA000390277Medicaid
43ZCBJA23Medicare ID - Type Unspecified