Healthcare Provider Details

I. General information

NPI: 1669414678
Provider Name (Legal Business Name): SANFORD G DUKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 HEMLOCK ST
MACON GA
31201-3202
US

IV. Provider business mailing address

540 HEMLOCK ST
MACON GA
31201-3202
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-8953
  • Fax: 478-743-1963
Mailing address:
  • Phone: 478-743-8953
  • Fax: 478-743-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number49885
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: