Provider Demographics
NPI:1275534190
Name:MCDONALD, MYRON TODD (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:TODD
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 STONEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-6226
Mailing Address - Country:US
Mailing Address - Phone:229-883-4045
Mailing Address - Fax:
Practice Address - Street 1:1010 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-1900
Practice Address - Country:US
Practice Address - Phone:229-776-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBKSTOtherMEDICARE
GA00969966AMedicaid
GA00969966AMedicaid
GAP62340Medicare UPIN