Provider Demographics
NPI:1831216522
Name:OKEEFE, DONNA RAE (PA)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:RAE
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:566 TUDOR BR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5836
Mailing Address - Country:US
Mailing Address - Phone:706-496-2382
Mailing Address - Fax:
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-9355
Practice Address - Fax:706-787-9356
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA3669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD000Medicare UPIN