Provider Demographics
NPI:1497821862
Name:HANEY, DONNA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MICHELLE
Last Name:HANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16125 BARNESVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:GA
Mailing Address - Zip Code:30295
Mailing Address - Country:US
Mailing Address - Phone:770-567-9593
Mailing Address - Fax:770-567-8192
Practice Address - Street 1:16125 BARNESVILLE STREET
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:GA
Practice Address - Zip Code:30295
Practice Address - Country:US
Practice Address - Phone:770-567-9593
Practice Address - Fax:770-567-8192
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP6516Medicare ID - Type Unspecified
G69833Medicare UPIN