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General NPI Number Information
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NPI Number | 1609881333
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Entity Type | Individual
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Provider Name | KATHLEEN A DURYEA D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 391 NORTHWOOD DR
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City | CENTRE
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State | AL
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Zip | 35960-1020
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Country | US
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Telephone | 256-927-7412
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Fax | 256-927-7416
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Provider Business Mailing Address
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Address Line | 420 E 2ND AVE STE 103
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City | ROME
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State | GA
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Zip | 30161-3210
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Country | US
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Telephone | 706-509-3000
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO564
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License Number State | AL
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