Provider Demographics
NPI:1659587301
Name:FAUZIA K. DURRANI M.D., PC
Entity Type:Organization
Organization Name:FAUZIA K. DURRANI M.D., PC
Other - Org Name:FAUZIA K. DURRANI M.D. ,PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FAUZIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DURRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-247-7753
Mailing Address - Street 1:107 WOODROW WILSON DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2539
Mailing Address - Country:US
Mailing Address - Phone:229-247-7753
Mailing Address - Fax:229-247-7849
Practice Address - Street 1:107 WOODROW WILSON DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2539
Practice Address - Country:US
Practice Address - Phone:229-247-7753
Practice Address - Fax:229-247-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000146143AMedicaid
GAD29356Medicare UPIN
GA256046859AMedicare ID - Type UnspecifiedMEDICARE ID NUMBER