Provider Demographics
NPI:1306978242
Name:MCDANIEL & DURRETT, P.C
Entity type:Organization
Organization Name:MCDANIEL & DURRETT, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-352-2850
Mailing Address - Street 1:105 COLLIER RD NW
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1710
Mailing Address - Country:US
Mailing Address - Phone:404-352-2850
Mailing Address - Fax:
Practice Address - Street 1:105 COLLIER RD NW
Practice Address - Street 2:SUITE 1080
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1710
Practice Address - Country:US
Practice Address - Phone:404-352-2850
Practice Address - Fax:404-352-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBBRFMedicare UPIN