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General NPI Number Information
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NPI Number | 1811084759
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Entity Type | Organization
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Legal Business Name | ATLANTA METRO UROLOGY CLINICS PC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 1275 HIGHWAY 54 W SUITE 205
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4549
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Country | US
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Telephone | 770-716-9656
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Fax | 770-716-1609
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Provider Business Mailing Address
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Address Line | 1275 HIGHWAY 54 W SUITE 205
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4549
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Country | US
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Telephone | 770-716-9656
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Fax | 770-716-1609
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FERNANDO A DURALDE
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Credential | M.D.
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Telephone | 770-716-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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