Provider Demographics
NPI:1952931479
Name:DONALDSON, SETH DANIEL
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:DANIEL
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 LEE ROAD 137 LOT 216
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-7506
Mailing Address - Country:US
Mailing Address - Phone:256-636-7252
Mailing Address - Fax:
Practice Address - Street 1:2038 LEE ROAD 137 LOT 216
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-7506
Practice Address - Country:US
Practice Address - Phone:256-636-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12703390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program