Provider Demographics
NPI:1265484208
Name:DURALDE, RODRIGO A (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:A
Last Name:DURALDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 PEACHTREE ST NW STE 750
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2530
Mailing Address - Country:US
Mailing Address - Phone:404-351-7654
Mailing Address - Fax:404-609-7605
Practice Address - Street 1:1800 PEACHTREE ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2519
Practice Address - Country:US
Practice Address - Phone:404-351-7654
Practice Address - Fax:404-609-7605
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA038224208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000645103HMedicaid
GA000645103HMedicaid
GA05BDGMXMedicare PIN