Active NPI
Donna Moultry Dorrough, PA
- Physician Assistant
- Birmingham, AL
National Provider Identifier
1144303900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA.1305
- Practice address
- 1201 11TH Ave S
Birmingham, AL 35205-3423 - Phone
- (205) 930-7100
- NPI assigned
- Oct 23, 2006
- Last updated
- Aug 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1038986 | ||
| Physician Assistant | 363A00000X | PA.1305 | AL | Primary |
Addresses
Primary practice location
1201 11TH Ave S
Birmingham, AL 35205-3423
Mailing address
PO Box 55310
Birmingham, AL 35255-5310
Phone (205) 731-9701
Other practice location 1
Camp Arifjan TMC
Building 179
Apo, AE 09366
KW
Phone 0119653891798
Other names 1
- Ms. Donna Faye Moultry
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.1305 | AL | MD | Physician Assistant |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565136000000",
"number": "1144303900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 55310",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352555310",
"telephone_number": "205-731-9701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 11TH AVE S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352053423",
"telephone_number": "205-930-7100"
}
],
"practiceLocations": [
{
"address_1": "Camp Arifjan TMC",
"address_2": "Building 179",
"address_purpose": "LOCATION",
"city": "APO",
"state": "AE",
"postal_code": "09366",
"country_code": "KW",
"telephone_number": "0119653891798",
"fax_number": "0119653891840",
"country_name": "Kuwait",
"address_type": "FGN"
}
],
"basic": {
"last_name": "DORROUGH",
"first_name": "DONNA",
"middle_name": "MOULTRY",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-23",
"last_updated": "2019-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": "1038986",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AL",
"license": "PA.1305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DONNA",
"last_name": "MOULTRY",
"middle_name": "FAYE",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.