Provider Demographics
NPI:1548352529
Name:MCDONALD, FRED MELVIN JR (ND, DOM, LAC)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:MELVIN
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:ND, DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 STONEBRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6037
Mailing Address - Country:US
Mailing Address - Phone:706-769-0720
Mailing Address - Fax:706-769-8754
Practice Address - Street 1:1351 STONEBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6037
Practice Address - Country:US
Practice Address - Phone:706-769-0720
Practice Address - Fax:706-769-8754
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000162171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000162OtherGA LIC#