Provider Demographics
NPI:1881240836
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:
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-401-2628
Mailing Address - Street 1:2230 TOWNE LAKE PKWY BLDG 200-100
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5548
Mailing Address - Country:US
Mailing Address - Phone:678-401-2628
Mailing Address - Fax:
Practice Address - Street 1:89 OLD TROLLEY RD STE 211
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-4951
Practice Address - Country:US
Practice Address - Phone:678-401-2628
Practice Address - Fax:877-832-9663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONACO MEDICAL SUPPLY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-15
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies