Provider Demographics
NPI:1720790538
Name:DURHAM, DENISE RENEE (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 MARS HILL RD STE 3400
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1104
Mailing Address - Country:US
Mailing Address - Phone:786-726-2227
Mailing Address - Fax:
Practice Address - Street 1:3651 MARS HILL RD STE 3400
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1104
Practice Address - Country:US
Practice Address - Phone:786-726-2227
Practice Address - Fax:706-203-4640
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN272923363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health