Provider Demographics
NPI:1578317673
Name:RONALD E. DURIE, JR., LLC
Entity Type:Organization
Organization Name:RONALD E. DURIE, JR., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DURIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-480-7292
Mailing Address - Street 1:2745 SANDY PLAINS RD STE 118
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4327
Mailing Address - Country:US
Mailing Address - Phone:770-977-1611
Mailing Address - Fax:
Practice Address - Street 1:2745 SANDY PLAINS RD STE 118
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4327
Practice Address - Country:US
Practice Address - Phone:770-977-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental