Individual
DONNELL BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2053 WELLBORN RD, LITHONIA, GA 30058-5460
(770) 742-6429
Mailing address
2053 WELLBORN RD, LITHONIA, GA 30058-5460
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
060911910
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060911910
060911910
GA
05
—
060911910
—
GA
Enumeration date
10/29/2020
Last updated
10/29/2020
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