Provider Demographics
NPI:1346574084
Name:DURALL CAPITAL HOLDINGS, LLC
Entity Type:Organization
Organization Name:DURALL CAPITAL HOLDINGS, LLC
Other - Org Name:DAHLONEGA FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:NATASHEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:706-265-8439
Mailing Address - Street 1:59 TIPTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533
Mailing Address - Country:US
Mailing Address - Phone:706-864-4012
Mailing Address - Fax:706-864-4029
Practice Address - Street 1:59 TIPTON DRIVE
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533
Practice Address - Country:US
Practice Address - Phone:706-864-4012
Practice Address - Fax:706-864-4029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DURALL CAPITAL HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QR1300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health