Provider Demographics
NPI:1144203290
Name:DUKES, DENNIS (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:DUKES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6820
Mailing Address - Country:US
Mailing Address - Phone:706-282-4363
Mailing Address - Fax:
Practice Address - Street 1:2003 FALLS RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-9700
Practice Address - Country:US
Practice Address - Phone:706-282-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027538207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000316126IMedicaid
GAHBP931Medicaid
GAD29345Medicare UPIN
GAHOSP25Medicare PIN
GAHBP931Medicaid