Provider Demographics
NPI:1043558158
Name:DONOVAN REHAB
Entity type:Organization
Organization Name:DONOVAN REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:678-860-2196
Mailing Address - Street 1:502 E GENERAL STEWART WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2642
Mailing Address - Country:US
Mailing Address - Phone:912-320-4737
Mailing Address - Fax:888-977-3418
Practice Address - Street 1:502 E GENERAL STEWART WAY STE C
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2643
Practice Address - Country:US
Practice Address - Phone:912-320-4737
Practice Address - Fax:888-977-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty