Provider Demographics
NPI:1396923892
Name:CORNWELL, DONALD JR
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CORNWELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2300
Mailing Address - Country:US
Mailing Address - Phone:276-228-5800
Mailing Address - Fax:321-914-0821
Practice Address - Street 1:325 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2300
Practice Address - Country:US
Practice Address - Phone:276-228-5800
Practice Address - Fax:321-914-0821
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002104237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist