Provider Demographics
NPI:1326234253
Name:MAYO, DONNA K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:K
Last Name:MAYO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 UNIVERSITY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-2792
Mailing Address - Country:US
Mailing Address - Phone:803-641-5651
Mailing Address - Fax:803-641-5625
Practice Address - Street 1:302 UNIVERSITY PARKWAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2792
Practice Address - Country:US
Practice Address - Phone:803-641-5661
Practice Address - Fax:803-641-5625
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1360363A00000X
IL085003050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0893PAMedicaid
SC0893PAMedicaid