Provider Demographics
NPI:1992946842
Name:DUANE FARMER P.C.
Entity type:Organization
Organization Name:DUANE FARMER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-552-0717
Mailing Address - Street 1:1175 CANTON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3616
Mailing Address - Country:US
Mailing Address - Phone:770-552-0717
Mailing Address - Fax:
Practice Address - Street 1:1175 CANTON ST
Practice Address - Street 2:STE 2
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3616
Practice Address - Country:US
Practice Address - Phone:770-552-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01876251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health