Provider Demographics
NPI:1376960179
Name:DURANT, JOSEPH (LMT, BA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:DURANT
Suffix:
Gender:M
Credentials:LMT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MACKAY CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-4525
Mailing Address - Country:US
Mailing Address - Phone:912-269-4534
Mailing Address - Fax:
Practice Address - Street 1:1111 GLYNCO PKWY
Practice Address - Street 2:STE. 400
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-7921
Practice Address - Country:US
Practice Address - Phone:912-269-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003512174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist