Basic Information
Provider Information | |||||||||
NPI: | 1770605891 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DONAHUE | ||||||||
FirstName: | KERRI | ||||||||
MiddleName: | GREER | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7400 LYNN AVE | ||||||||
Address2: |   | ||||||||
City: | HAMLIN | ||||||||
State: | WV | ||||||||
PostalCode: | 255231138 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3048245806 | ||||||||
FaxNumber: | 3048245885 | ||||||||
Practice Location | |||||||||
Address1: | 7400 LYNN AVE | ||||||||
Address2: |   | ||||||||
City: | HAMLIN | ||||||||
State: | WV | ||||||||
PostalCode: | 255231138 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3048245806 | ||||||||
FaxNumber: | 3048245804 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/06/2007 | ||||||||
LastUpdateDate: | 03/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 001218 | GA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 23202 | WV | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | P00654861 | 01 |   | RAILROAD MEDICARE | OTHER | 3810012810 | 05 | WV |   | MEDICAID | 1770605891 | 05 | KY |   | MEDICAID | 2869338 | 05 | OH |   | MEDICAID |