Provider Demographics
NPI:1699091819
Name:WEBB, DONNA FAYE (DPH)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:FAYE
Last Name:WEBB
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3243
Mailing Address - Country:US
Mailing Address - Phone:423-842-3500
Mailing Address - Fax:423-842-7483
Practice Address - Street 1:5604 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3243
Practice Address - Country:US
Practice Address - Phone:423-842-3500
Practice Address - Fax:423-842-7483
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1452799OtherMEDICARE PTAN 386682006