MEDICARE: BARBARA BOYD DURHAM

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	172A00000X	Driver	T69532843	VA

General Provider Information

NPI Number	:	1841714227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA BOYD DURHAM

Provider Business Mailing Address
First Line	:	720 BRODNAX RD
Second Line	:
City	:	BRODNAX
State	:	VA
Zip	:	23920-2809
Country	:	US
Telephone Number	:	434-321-2732
Fax Number	:

Provider Business Practice Location Address
First Line	:	4751 BEST RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30337-5615
Country	:	US
Telephone Number	:	844-856-7907
Fax Number	:

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

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	07/27/2017

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