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General NPI Number Information
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NPI Number | 1447374509
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Entity Type | Individual
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Provider Name | DEWAYNE DURHAM DPO
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7002 SHALLOWFORD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1715
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Country | US
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Telephone | 423-499-0810
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 MILLSTONE DR
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City | OOLTEWAH
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State | TN
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Zip | 37363-6859
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Country | US
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Telephone | 423-238-6821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | TN0844
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License Number State | TN
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