Provider Demographics
NPI:1568651321
Name:DURNELL, WESTLEY MICHAEL (MDR)
Entity Type:Individual
Prefix:
First Name:WESTLEY
Middle Name:MICHAEL
Last Name:DURNELL
Suffix:
Gender:M
Credentials:MDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 WOODBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-3380
Mailing Address - Country:US
Mailing Address - Phone:912-573-2939
Mailing Address - Fax:912-573-4534
Practice Address - Street 1:580 USS MARIANO G. VALLEJO AVE
Practice Address - Street 2:NSSC MEDICAL
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31547
Practice Address - Country:US
Practice Address - Phone:912-573-2939
Practice Address - Fax:912-573-4534
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman