Provider Demographics
NPI:1568532729
Name:JABLONSKI, DONALD EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EDWARD
Last Name:JABLONSKI
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 1:2 ETOWAH SCHOOL ROAD
Mailing Address - Street 2:PO BOX 2108
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-1925
Mailing Address - Country:US
Mailing Address - Phone:828-890-3200
Mailing Address - Fax:
Practice Address - Street 1:2 ETOWAH SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:NC
Practice Address - Zip Code:28729-1925
Practice Address - Country:US
Practice Address - Phone:828-890-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO39913207Q00000X
NC9501669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2400576EOtherMEDICARE
NC2400576DOtherMEDICARE ID-TYPE UNSPECIFIED
NCP00933350OtherRR MEDICARE