Provider Demographics
NPI:1396710794
Name:MCDONALD, MARY KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80883
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0883
Mailing Address - Country:US
Mailing Address - Phone:706-549-0151
Mailing Address - Fax:706-993-3343
Practice Address - Street 1:5211 HIGHWAY 153
Practice Address - Street 2:SUITE M
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4956
Practice Address - Country:US
Practice Address - Phone:423-648-7667
Practice Address - Fax:423-648-6279
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28536208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00194880OtherMEDICARE RAILROAD
TN4097642OtherBLUE CROSS AND BLUE SHIELD
TN3728147Medicare PIN
P00194880OtherMEDICARE RAILROAD