Provider Demographics
NPI:1649363300
Name:DURASKI, ROD M (MD)
Entity type:Individual
Prefix:DR
First Name:ROD
Middle Name:M
Last Name:DURASKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-7700
Mailing Address - Country:US
Mailing Address - Phone:706-845-3494
Mailing Address - Fax:706-845-3575
Practice Address - Street 1:1514 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4131
Practice Address - Country:US
Practice Address - Phone:706-882-1411
Practice Address - Fax:205-874-8333
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30296207R00000X, 208M00000X
GA030296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11BDMSKMedicare ID - Type Unspecified
C73301Medicare UPIN
GA00643464BMedicare ID - Type Unspecified