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NPI Code Detail

MEDICARE: DR. LYNLEY SUZANNE DURRETT M.D.

MEDICARE: DR. LYNLEY SUZANNE DURRETT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist044912GA

General Provider Information

NPI Number : 1073501169
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYNLEY SUZANNE DURRETT M.D.
Provider Business Mailing Address
First Line : 105 COLLIER RD NW
Second Line : SUITE 1080
City : ATLANTA
State : GA
Zip : 30309-1710
Country : US
Telephone Number : 404-352-2850
Fax Number : 404-352-0947
Provider Business Practice Location Address
First Line : 105 COLLIER RD NW
Second Line : SUITE 1080
City : ATLANTA
State : GA
Zip : 30309-1710
Country : US
Telephone Number : 404-352-2850
Fax Number : 404-352-0947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 06/21/2010

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