Provider Demographics
NPI:1831274752
Name:DURDEN, MARILYN L (DC)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:L
Last Name:DURDEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:LALKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 142216
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6511
Mailing Address - Country:US
Mailing Address - Phone:770-631-7600
Mailing Address - Fax:770-774-0122
Practice Address - Street 1:120 HANDLEY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2177
Practice Address - Country:US
Practice Address - Phone:770-631-7600
Practice Address - Fax:770-774-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGLNOtherCARRIER PROVIDER NUMBER
GAU86222Medicare UPIN