Provider Demographics
NPI:1255518007
Name:DURBIN, RANDY EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:EDWARD
Last Name:DURBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 GRANGEHILL WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6204
Mailing Address - Country:US
Mailing Address - Phone:404-402-2078
Mailing Address - Fax:
Practice Address - Street 1:5677 BUFORD HWY NE STE 210
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1243
Practice Address - Country:US
Practice Address - Phone:678-547-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000003188208D00000X
NC2024-01606208D00000X
KY03371208D00000X
GA64776208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice