Healthcare Provider Details

I. General information

NPI: 1285067280
Provider Name (Legal Business Name): DUREN CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 JV MANGUBAT DR
WAYNESBORO TN
38485-2440
US

IV. Provider business mailing address

107 JV MANGUBAT DR
WAYNESBORO TN
38485-2440
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5466
  • Fax: 931-722-9495
Mailing address:
  • Phone: 931-722-2296
  • Fax: 931-722-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. JERRY MCCLAIN DUREN
Title or Position: OWNER
Credential: D.PH.
Phone: 931-722-5466