Basic Information
| Provider Information | |||||||||
| NPI: | 1962072017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MABO | ||||||||
| FirstName: | DONICIA | ||||||||
| MiddleName: | RAILEY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | EASTMAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310236718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783741801 | ||||||||
| FaxNumber: | 4784484586 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 GRIFFIN AVE # EASTMAN | ||||||||
| Address2: | |||||||||
| City: | EASTMAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310236718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783741801 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN242109 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.