Provider Demographics
NPI:1154417277
Name:SALLY, DONALD E (PA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:E
Last Name:SALLY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:4030 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3011
Mailing Address - Country:US
Mailing Address - Phone:770-921-4811
Mailing Address - Fax:770-921-7943
Practice Address - Street 1:4030 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2823
Practice Address - Country:US
Practice Address - Phone:770-921-4811
Practice Address - Fax:770-921-7943
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-03-23
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Provider Licenses
StateLicense IDTaxonomies
GA002071363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical