Provider Demographics
NPI:1760974463
Name:DURDEN, ANDRELL
Entity Type:Individual
Prefix:
First Name:ANDRELL
Middle Name:
Last Name:DURDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-0245
Mailing Address - Country:US
Mailing Address - Phone:229-507-0156
Mailing Address - Fax:
Practice Address - Street 1:131 S BURWELL AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2624
Practice Address - Country:US
Practice Address - Phone:229-507-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor