Provider Demographics
NPI:1427484237
Name:DONELSON, ANDREW JACKSON JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JACKSON
Last Name:DONELSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 NEWBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1580
Mailing Address - Country:US
Mailing Address - Phone:270-791-3242
Mailing Address - Fax:
Practice Address - Street 1:841 NEWBERRY ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1580
Practice Address - Country:US
Practice Address - Phone:270-791-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY17193207V00000X
TN6152207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology