Provider Demographics
NPI:1477596591
Name:WILLOUGHBY, DONALD O (PA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:O
Last Name:WILLOUGHBY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:6262 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3540
Mailing Address - Country:US
Mailing Address - Phone:706-324-6661
Mailing Address - Fax:706-327-6701
Practice Address - Street 1:6262 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3540
Practice Address - Country:US
Practice Address - Phone:706-324-6661
Practice Address - Fax:706-327-6701
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA000622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S45924Medicare UPIN
GA97WCGJSMedicare PIN