Provider Demographics
NPI:1134954340
Name:DONALD, DORETHA SHANTE (OWNER)
Entity type:Individual
Prefix:MRS
First Name:DORETHA
Middle Name:SHANTE
Last Name:DONALD
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 SUNSET DOWN CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7927
Mailing Address - Country:US
Mailing Address - Phone:717-614-7812
Mailing Address - Fax:
Practice Address - Street 1:764 SUNSET DOWN CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7927
Practice Address - Country:US
Practice Address - Phone:717-614-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care