Provider Demographics
NPI:1225106933
Name:DONHAM, MICHAEL C (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:DONHAM
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 1:1215 7TH STREET SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3371
Mailing Address - Country:US
Mailing Address - Phone:256-306-1655
Mailing Address - Fax:256-306-1601
Practice Address - Street 1:1215 7TH STREET SE
Practice Address - Street 2:SUITE 110
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3371
Practice Address - Country:US
Practice Address - Phone:256-306-1655
Practice Address - Fax:256-306-1601
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL18258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529902310Medicaid
AL000046355Medicaid
AL1982805149Medicare PIN
AL529902310Medicaid
ALF82450Medicare UPIN
AL000046355Medicare PIN
AL1225106933Medicare PIN