Provider Demographics
NPI:1275054629
Name:DURHAM, JOAN LAVERNE
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:LAVERNE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 BEST RD STE 215
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30337-5607
Mailing Address - Country:US
Mailing Address - Phone:404-500-4216
Mailing Address - Fax:678-623-3691
Practice Address - Street 1:4751 BEST RD STE 215
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-5607
Practice Address - Country:US
Practice Address - Phone:404-500-4216
Practice Address - Fax:678-623-3691
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT69514488347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker