Provider Demographics
NPI:1629888474
Name:TINY DUCKY, LLC
Entity type:Organization
Organization Name:TINY DUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-559-3186
Mailing Address - Street 1:2820 LASSITER RD STE 100
Mailing Address - Street 2:BLDG B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8332
Mailing Address - Country:US
Mailing Address - Phone:770-559-3186
Mailing Address - Fax:
Practice Address - Street 1:2820 LASSITER RD STE 100
Practice Address - Street 2:BLDG B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8332
Practice Address - Country:US
Practice Address - Phone:770-559-3186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty