Provider Demographics
NPI:1639214208
Name:DONOHUE, JAMES KEVIN (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEVIN
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6094 ODELL ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5704
Mailing Address - Country:US
Mailing Address - Phone:770-846-5628
Mailing Address - Fax:
Practice Address - Street 1:6094 ODELL ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-5704
Practice Address - Country:US
Practice Address - Phone:770-846-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005759111NX0800X, 111NR0200X, 111NR0400X, 111NS0005X, 111NX0800X
GA7633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiology
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5381641OtherAETNA
DE2193566OtherAETNA
GA35ZCFDLMedicare ID - Type UnspecifiedCHIROPRACTIC
GA5381641OtherAETNA