Provider Demographics
NPI:1417089368
Name:DONALDSON, MICHAEL RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8681 HIGHWAY 92
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6513
Mailing Address - Country:US
Mailing Address - Phone:678-398-7338
Mailing Address - Fax:
Practice Address - Street 1:8681 HIGHWAY 92
Practice Address - Street 2:SUITE 308
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6513
Practice Address - Country:US
Practice Address - Phone:678-398-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66846Medicare UPIN
GA35ZCDVS01Medicare ID - Type Unspecified