Provider Demographics
NPI:1942695358
Name:DONALD H. DEATON, DO
Entity Type:Organization
Organization Name:DONALD H. DEATON, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:865-278-4074
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-0473
Mailing Address - Country:US
Mailing Address - Phone:865-278-4074
Mailing Address - Fax:
Practice Address - Street 1:1601 TAZEWELL RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3609
Practice Address - Country:US
Practice Address - Phone:865-278-4074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512317Medicaid