Healthcare Provider Details

I. General information

NPI: 1073799490
Provider Name (Legal Business Name): FREDERICK LETOIS DURDEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CELEBRATE LIFE PKWY SUITE 350
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

600 CELEBRATE LIFE PKWY SUITE 350
NEWNAN GA
30265-8001
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-7620
  • Fax:
Mailing address:
  • Phone: 770-400-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35097442
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number000792
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number065539
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: