Provider Demographics
NPI:1962796680
Name:ROSS, DONNA LYNN (RN, CCM)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 PATHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7787
Mailing Address - Country:US
Mailing Address - Phone:770-474-9086
Mailing Address - Fax:
Practice Address - Street 1:684 PATHWOOD LN
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7787
Practice Address - Country:US
Practice Address - Phone:770-474-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN116397163WA2000X, 163WC0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator