Basic Information
| Provider Information | |||||||||
| NPI: | 1831216522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKEEFE | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 566 TUDOR BR | ||||||||
| Address2: | |||||||||
| City: | GROVETOWN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308135836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064962382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 W HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | FORT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067879355 | ||||||||
| FaxNumber: | 7067879356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 3669 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.