Provider Demographics
NPI:1033106158
Name:DOUTE, DAMIEN ANTOINE (MD)
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:ANTOINE
Last Name:DOUTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 MONTREAL ROAD
Mailing Address - Street 2:STE 218
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:470-294-0863
Mailing Address - Fax:404-294-0889
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:STE 218
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:470-294-0863
Practice Address - Fax:470-294-0889
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53852174400000X
GA053852174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA728513163AMedicaid
20NCCCSMedicare PIN
GA728513163AMedicaid
GAG06468Medicare UPIN