Provider Demographics
NPI:1841714227
Name:DURHAM, BARBARA BOYD
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:BOYD
Last Name:DURHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BRODNAX RD
Mailing Address - Street 2:
Mailing Address - City:BRODNAX
Mailing Address - State:VA
Mailing Address - Zip Code:23920-2809
Mailing Address - Country:US
Mailing Address - Phone:434-321-2732
Mailing Address - Fax:
Practice Address - Street 1:4751 BEST RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-5615
Practice Address - Country:US
Practice Address - Phone:844-856-7907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT69532843172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver