Provider Demographics
NPI:1497865901
Name:O'DONNELL, CAROLINE DIDONATO (NP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:DIDONATO
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:JOANN
Other - Last Name:DIDONATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3215 CAMPUS LOOP RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3227
Mailing Address - Country:US
Mailing Address - Phone:470-578-6644
Mailing Address - Fax:470-578-9004
Practice Address - Street 1:3215 CAMPUS LOOP RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3227
Practice Address - Country:US
Practice Address - Phone:470-578-6644
Practice Address - Fax:470-578-9004
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN071559363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000853102CMedicaid
SCNP0727Medicaid
S95511Medicare UPIN