MEDICARE: DUANE ENNIS R, CT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number
1	247100000X	Radiologic Technologist	364369
2	2471C3401X	Computed Tomography Radiologic Technologist	364369
3	2471C3402X	Radiography Radiologic Technologist	364369

General Provider Information

NPI Number	:	1891706214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE ENNIS R, CT

Provider Business Mailing Address
First Line	:	301 CANTERFIELD DR
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005-3363
Country	:	US
Telephone Number	:	478-918-0419
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 HARDEMAN AVE
Second Line	:	SUITE B
City	:	MACON
State	:	GA
Zip	:	31201-1416
Country	:	US
Telephone Number	:	478-745-3135
Fax Number	:	478-745-3136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	09/11/2025

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Directions to “ DUANE ENNIS R, CT” Practice Location

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