Provider Demographics
NPI:1649531344
Name:DONACO MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:DONACO MEDICAL SUPPLY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PATIENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-401-2628
Mailing Address - Street 1:2295 TOWNE LAKE PKWY
Mailing Address - Street 2:SUITE 116-237
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5520
Mailing Address - Country:US
Mailing Address - Phone:678-401-2628
Mailing Address - Fax:
Practice Address - Street 1:2230 TOWNE LAKE PKWY
Practice Address - Street 2:BLDG 200 STE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5540
Practice Address - Country:US
Practice Address - Phone:678-401-2628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies