Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 000792 | GA |
Y | 208200000X | Surgeon | 35097442 | OH |
Y | 208600000X | Surgeon | 35097442 | OH |
NPI | 1073799490 |
---|---|
Provider Name | Dr. Frederick Letois Durden JR. |
First Address | Newnan, GA 30265-8001 |
Second Address | Newnan, GA 30265-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2008 |
Last Update Date | 19/12/2015 |