Provider Demographics
NPI:1417209149
Name:ROSS, DONNA V
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:V
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2133
Mailing Address - Country:US
Mailing Address - Phone:229-563-7946
Mailing Address - Fax:
Practice Address - Street 1:2122 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2133
Practice Address - Country:US
Practice Address - Phone:229-563-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator