Provider Demographics
NPI:1801203666
Name:DONAHUE, KIMBERLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1825 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2273
Mailing Address - Country:US
Mailing Address - Phone:770-393-9000
Mailing Address - Fax:770-393-9006
Practice Address - Street 1:1825 OLD ALABAMA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2273
Practice Address - Country:US
Practice Address - Phone:770-393-9000
Practice Address - Fax:770-393-9006
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA7197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant