Provider Demographics
NPI:1447222112
Name:MCDONALD, WILLIAM H (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:H
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12289 LESTER TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-2721
Mailing Address - Country:US
Mailing Address - Phone:205-339-6490
Mailing Address - Fax:205-348-9932
Practice Address - Street 1:323 PAUL BRYANT DR.
Practice Address - Street 2:BOX 870323
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0001
Practice Address - Country:US
Practice Address - Phone:205-348-3651
Practice Address - Fax:205-348-9932
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL172A00000X172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL785597OtherNATA CERTIFICATION
AL063OtherLICENSE