Provider Demographics
NPI:1245323054
Name:DURANT, ALAN DWAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DWAYNE
Last Name:DURANT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-1530
Mailing Address - Country:US
Mailing Address - Phone:706-554-9442
Mailing Address - Fax:
Practice Address - Street 1:300 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1511
Practice Address - Country:US
Practice Address - Phone:706-554-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1272-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000479674BMedicaid
GA000479674AMedicaid
GAU25482Medicare UPIN