Provider Demographics
NPI:1497747778
Name:POLK, DONALD H (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:POLK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-0778
Mailing Address - Country:US
Mailing Address - Phone:931-722-3677
Mailing Address - Fax:931-722-9052
Practice Address - Street 1:206 CLIFTON TPKE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2301
Practice Address - Country:US
Practice Address - Phone:931-722-3677
Practice Address - Fax:931-722-9052
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNDO127207Q00000X
TNDO127207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3300793Medicaid
TNB04883Medicare UPIN
3302392Medicare ID - Type Unspecified
TN3300793Medicaid