Provider Demographics
NPI:1902900624
Name:MCDONOUGH, JEAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:P
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1348 WALTON WAY
Mailing Address - Street 2:STE 4100
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5107
Mailing Address - Country:US
Mailing Address - Phone:706-724-2261
Mailing Address - Fax:706-724-2523
Practice Address - Street 1:1430 HARPER ST
Practice Address - Street 2:BLDG A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-724-2261
Practice Address - Fax:706-724-2523
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2021-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA056154207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA720005146AMedicaid
GA16BBCRWMedicare ID - Type Unspecified
G97052Medicare UPIN