Provider Demographics
NPI:1174629414
Name:AJO, DONNA M (PA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:AJO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:504 BROAD ST
Mailing Address - Street 2:APT A
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1843
Mailing Address - Country:US
Mailing Address - Phone:678-755-5248
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL PAVILION DR STE 150
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-0030
Practice Address - Country:US
Practice Address - Phone:910-904-8025
Practice Address - Fax:910-615-9751
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002353207Q00000X
NC0010-00988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002353OtherLICINCE