Jaclyn Kaylor Donovan, MBA, MS, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT000935 Issued in GA

Practice address

3100 Veterans Pkwy S
Vereen Rehabilitation Center
Moultrie, GA 31788-9400

Phone

(229) 890-3553

Fax

(229) 890-5331

NPI assigned

Apr 20, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration, Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colquitt Regional Medical Center

  • General Acute Care Hospital
  • Moultrie, GA
  • NPI 1912099094
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397606400000",
    "number": "1295952042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "address_2": "VEREEN REHABILITATION CENTER",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317760040",
            "telephone_number": "229-890-3553",
            "fax_number": "229-890-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 VETERANS PKWY S",
            "address_2": "VEREEN REHABILITATION CENTER",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317889400",
            "telephone_number": "229-890-3553",
            "fax_number": "229-890-5331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOVAN",
        "first_name": "JACLYN",
        "middle_name": "KAYLOR",
        "name_prefix": "Ms.",
        "credential": "MBA, MS, ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2014-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT000935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Diers, NP
• Joshua P Dietzer, M.D.
• Heather G Dismuke, FNP-BC
• Daniel Rustin Dixon
• Woodly Terry Dominique
• Laura Lee Durham, CCC/SLP
• Laura Dominy Durrence
• Mary Catherine Seabrook Duskin, DO
• Eb & J Medical Inc
• Barbara Eileen Ebert, MD

• Athletic Trainer in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.