Healthcare Provider Details

I. General information

NPI: 1366435182
Provider Name (Legal Business Name): HECTOR M. DOURRON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 BURLEYSON RD STE 202
DALTON GA
30720-3094
US

IV. Provider business mailing address

1109 BURLEYSON RD STE 202
DALTON GA
30720-3094
US

V. Phone/Fax

Practice location:
  • Phone: 706-259-3336
  • Fax: 706-370-7715
Mailing address:
  • Phone: 706-259-3336
  • Fax: 706-370-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number052556
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number54489
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: