Provider Demographics
NPI:1407950876
Name:EDMOND-KING, DONNA (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:EDMOND-KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:EDMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-888-6559
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:1712-C EAST BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705
Practice Address - Country:US
Practice Address - Phone:229-639-3103
Practice Address - Fax:229-888-8935
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044711208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4512970OtherAETNA
GA000777378AMedicaid
GA727446OtherBCBS
GA370010386OtherRR MCARE
GA727446OtherBCBS
GA37BBDZNMedicare ID - Type Unspecified