Healthcare Provider Details

I. General information

NPI: 1215360664
Provider Name (Legal Business Name): HEATHER NICOLE DUKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1611
US

IV. Provider business mailing address

5605 GLENRIDGE DR STE 325
ATLANTA GA
30342-1301
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6323
  • Fax:
Mailing address:
  • Phone: 404-252-4709
  • Fax: 404-252-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number95465
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2022012490
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: