Provider Demographics
NPI:1417420852
Name:HORNE, DUSTIN COLE (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:COLE
Last Name:HORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST UNIT 201
Practice Address - Street 2:
Practice Address - City:JEKYLL ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31527-1064
Practice Address - Country:US
Practice Address - Phone:912-766-0755
Practice Address - Fax:912-766-0775
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine