Provider Demographics
NPI:1073501169
Name:DURRETT, LYNLEY SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNLEY
Middle Name:SUZANNE
Last Name:DURRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COLLIER RD NW
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1710
Mailing Address - Country:US
Mailing Address - Phone:404-352-2850
Mailing Address - Fax:404-352-0947
Practice Address - Street 1:105 COLLIER RD NW
Practice Address - Street 2:SUITE 1080
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1710
Practice Address - Country:US
Practice Address - Phone:404-352-2850
Practice Address - Fax:404-352-0947
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044912174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBBRFMedicare PIN