Provider Demographics
NPI:1558503409
Name:MCDONALD, JULIA IRENE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:IRENE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:JULIA
Other - Middle Name:IRENE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:450 NORTHSIDE CHEROKEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8015
Mailing Address - Country:US
Mailing Address - Phone:770-224-1000
Mailing Address - Fax:770-224-2451
Practice Address - Street 1:450 NORTHSIDE CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8015
Practice Address - Country:US
Practice Address - Phone:770-224-1000
Practice Address - Fax:770-224-2451
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1793363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003119893FMedicaid
GA003119893JMedicaid
GA003119893KMedicaid
GA003119893EMedicaid
GA003119893GMedicaid
GA003119893KMedicaid