Provider Demographics
NPI:1013440056
Name:DURANT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DURANT
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 1:3225 KIRBY WHITTEN RD STE 201 #3
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2893
Mailing Address - Country:US
Mailing Address - Phone:901-608-1814
Mailing Address - Fax:
Practice Address - Street 1:3225 KIRBY WHITTEN RD STE 201 #3
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2893
Practice Address - Country:US
Practice Address - Phone:901-608-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN068364833172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver