Provider Demographics
NPI:1598713232
Name:ROMAN, DONATO (MD)
Entity Type:Individual
Prefix:
First Name:DONATO
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COMMISSIONER DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-9487
Mailing Address - Country:US
Mailing Address - Phone:912-437-9300
Mailing Address - Fax:912-437-9481
Practice Address - Street 1:1000 COMMISSIONER DR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-9487
Practice Address - Country:US
Practice Address - Phone:912-437-9300
Practice Address - Fax:912-437-9481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012855103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC75888Medicare UPIN
GA26BDKDWMedicare ID - Type Unspecified