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General NPI Number Information
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NPI Number | 1457556375
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Entity Type | Organization
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Legal Business Name | DURDEN MEDICAL CLINIC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 NORMAN DORMINY DR SUITE A
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City | FITZGERALD
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State | GA
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Zip | 31750-8858
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Country | US
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Telephone | 229-423-4333
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Fax | 229-423-0928
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Provider Business Mailing Address
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Address Line | PO BOX 480
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City | FITZGERALD
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State | GA
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Zip | 31750-0480
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Country | US
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Telephone | 229-423-4333
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Fax | 229-423-0928
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES H. DURDEN
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Credential | MD
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Telephone | 229-423-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 011322
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License Number State | GA
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