Healthcare Provider Details

I. General information

NPI: 1053504126
Provider Name (Legal Business Name): GEORGE T DUKES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22725 HIGHWAY 76 E CLINTON
CLINTON SC
29325-7527
US

IV. Provider business mailing address

1 INDEPENDENCE PT GREENVILLE
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-6400
  • Fax:
Mailing address:
  • Phone: 864-797-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number661
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: