Healthcare Provider Details

I. General information

NPI: 1467479089
Provider Name (Legal Business Name): NICHOLAS DUQUETTE MAYFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 WARM SPRINGS RD
COLUMBUS GA
31904-5323
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-8575
US

V. Phone/Fax

Practice location:
  • Phone: 706-323-3491
  • Fax:
Mailing address:
  • Phone: 864-359-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number060668
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number060668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: