Provider Demographics
NPI:1366244824
Name:DURU, LILIAN KELECHI (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:KELECHI
Last Name:DURU
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:KELECHI
Other - Last Name:DURU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 SEAWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8404
Mailing Address - Country:US
Mailing Address - Phone:404-988-8663
Mailing Address - Fax:
Practice Address - Street 1:3995 S COBB DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6342
Practice Address - Country:US
Practice Address - Phone:404-988-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247464163W00000X, 163WP0807X, 163WP0809X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult