Provider Demographics
NPI:1841324803
Name:DONALD J. MIRATE, M.D., P.C.
Entity type:Organization
Organization Name:DONALD J. MIRATE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MIRATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-242-8852
Mailing Address - Street 1:2707 N FORREST ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2057
Mailing Address - Country:US
Mailing Address - Phone:229-242-8852
Mailing Address - Fax:229-247-2609
Practice Address - Street 1:2707 N FORREST ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2057
Practice Address - Country:US
Practice Address - Phone:229-242-8852
Practice Address - Fax:229-247-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21261207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00300121AMedicaid
GA00300121AMedicaid
A72187Medicare UPIN
128388738AMedicare ID - Type Unspecified