Provider Demographics
NPI:1346242823
Name:DONNELLY, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:4800 OLDE TOWNE PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:770-977-1510
Practice Address - Fax:770-509-8858
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-03-23
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Provider Licenses
StateLicense IDTaxonomies
GA028398207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000356023CMedicaid
GA000356023DMedicaid
GA000356023EMedicaid
GA000356023DMedicaid