Provider Demographics
NPI:1710042676
Name:DONATO, KAREN J M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:J M
Last Name:DONATO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:JM
Other - Last Name:DONATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2251 WEST ELM STREET
Mailing Address - Street 2:P O BOX 371
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-2017
Mailing Address - Country:US
Mailing Address - Phone:478-864-3448
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:4292 GRAY HWY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5900
Practice Address - Country:US
Practice Address - Phone:478-986-2500
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5208OtherGEORGIA LICENSE