Provider Demographics
NPI:1992873517
Name:DONDANVILLE, REBECCA ABIGAIL (ATC, EDD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ABIGAIL
Last Name:DONDANVILLE
Suffix:
Gender:F
Credentials:ATC, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MALLARD POND CIR
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:GA
Mailing Address - Zip Code:30510-3033
Mailing Address - Country:US
Mailing Address - Phone:704-221-1311
Mailing Address - Fax:
Practice Address - Street 1:1021 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-778-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06632255A2300X
GAAT0024312255A2300X
FLAL 5662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
029602556OtherBOARD OF CERTIFICATION