Provider Demographics
NPI:1841410560
Name:MAUNEY, DONALD E (PA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:MAUNEY
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 1:299 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2155
Mailing Address - Country:US
Mailing Address - Phone:770-867-2120
Mailing Address - Fax:
Practice Address - Street 1:299 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2155
Practice Address - Country:US
Practice Address - Phone:770-867-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001408OtherSTATE LICENSE
GA822855513AMedicaid
GA822855513AMedicaid
GA001408OtherSTATE LICENSE