Doctor Name: | MR. MYRON TODD MCDONALD |
NPI Number: | 1275534190 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-C |
License Number: | RN115747 |
Business Practice Address: | 1010 W Franklin St Sylvester, GA - 317911900 |
Business Phone Number: | 2297763500 |
Business Fax Number: | |
Mailing Address: | 2805 Stonewater Dr, ALBANY |
State: | GA |
Postal Code: | 317216226 |
Phone Number: | 2298834045 |
Fax Number: | |
NPI Enumeration Date: | 08/02/2005 |
NPI Last Update Date: | 06/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN115747 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |