Provider Demographics
NPI:1699158659
Name:DURHAM, TORI (WHNP-BP)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:WHNP-BP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2577
Mailing Address - Country:US
Mailing Address - Phone:770-729-1600
Mailing Address - Fax:
Practice Address - Street 1:5720 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2577
Practice Address - Country:US
Practice Address - Phone:770-729-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171334363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health