Provider Demographics
NPI:1245614973
Name:PHILBRICK, DONOVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:
Last Name:PHILBRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 SPRING STREET, OFFICE OF INPATIENT MEDICINE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-9000
Mailing Address - Fax:770-219-6021
Practice Address - Street 1:743 SPRING STREET, OFFICE OF INPATIENT MEDICINE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-219-9000
Practice Address - Fax:770-219-6021
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA080148208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program