Provider Demographics
NPI:1750383212
Name:DONELSON, DAVID M (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:DONELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27169
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-7169
Mailing Address - Country:US
Mailing Address - Phone:864-987-0034
Mailing Address - Fax:864-987-0036
Practice Address - Street 1:1 HALTON GREEN WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-987-0034
Practice Address - Fax:864-987-0036
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10906207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC109064 GP#PC4223Medicaid
SC109064Medicaid
SC10906OtherMEDICAL LICENSE
SC2955Medicare PIN
SC109064 GP#PC4223Medicaid