1831274752 NPI number — DR. MARILYN L DURDEN D.C.

Table of content: DR. MARILYN L DURDEN D.C. (NPI 1831274752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831274752 NPI number — DR. MARILYN L DURDEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURDEN
Provider First Name:
MARILYN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LALKA
Provider Other First Name:
MARILYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831274752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 142216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-631-7600
Provider Business Mailing Address Fax Number:
770-774-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 HANDLEY RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
TYRONE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30290-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-631-7600
Provider Business Practice Location Address Fax Number:
770-774-0122
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5438 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 35ZCGLN . This is a "CARRIER PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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