Provider Demographics
NPI:1467436600
Name:MCDONALD, ANDREW T (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:T
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CAVENDER ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1931
Mailing Address - Country:US
Mailing Address - Phone:770-253-6616
Mailing Address - Fax:770-254-6181
Practice Address - Street 1:15 CAVENDER ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1931
Practice Address - Country:US
Practice Address - Phone:770-253-6616
Practice Address - Fax:770-254-6181
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029211207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40606Medicare UPIN
GA00373227AMedicaid