MEDICARE: RHONDA MICHELLE DURHAM A-GNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	RN154981	GA
2	363LP2300X	Primary Care Nurse Practitioner	APN.21872RX	SC
3	163W00000X	Registered Nurse	RN154981	GA

General Provider Information

NPI Number	:	1407396609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA MICHELLE DURHAM A-GNP-C

Provider Business Mailing Address
First Line	:	1662 MARS AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3825
Country	:	US
Telephone Number	:	216-712-6556
Fax Number	:	216-712-6596

Provider Business Practice Location Address
First Line	:	60 OKATIE VILLAGE DR
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-6554
Country	:	US
Telephone Number	:	843-548-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	05/29/2026

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