Organization Name: | RANDY E. DURBIN, DO, PC |
NPI Number: | 1396153292 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RANDY E DURBIN (PRESIDENT/CEO) |
Mailing Address: | 800 Old Dawson Village Rd E Suite 020 Dawsonville |
State: | GA US |
Postal Code: | 305343816 |
Phone Number: | 7062167188 |
Fax Number: | 8558842774 |
NPI Enumeration Date: | 07/24/2014 |
NPI Last Update Date: | 07/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |