Provider Demographics
NPI:1578928909
Name:DONNELLY, ROSEMARY JANECKI (APRN, ADULT NP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:JANECKI
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:APRN, ADULT NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SILVERTHORNE PT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6827
Mailing Address - Country:US
Mailing Address - Phone:678-362-6627
Mailing Address - Fax:
Practice Address - Street 1:2140 PEACHTREE RD NW STE 232
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1316
Practice Address - Country:US
Practice Address - Phone:888-708-0561
Practice Address - Fax:404-585-2688
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPAN716363LA2200X
GARN102940363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003184686AMedicaid