Provider Demographics
NPI:1023375698
Name:DURRETT, ROBERT ELDO III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELDO
Last Name:DURRETT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2308
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-2308
Mailing Address - Country:US
Mailing Address - Phone:931-552-0858
Mailing Address - Fax:931-645-1923
Practice Address - Street 1:140 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3109
Practice Address - Country:US
Practice Address - Phone:931-552-0858
Practice Address - Fax:931-645-1923
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00024330171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications