Provider Demographics
NPI:1912345273
Name:DURRETT CONSTRUCTION
Entity Type:Organization
Organization Name:DURRETT CONSTRUCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-270-9191
Mailing Address - Street 1:3926 GREENLEAF AVENUE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:843-270-9191
Mailing Address - Fax:
Practice Address - Street 1:3926 GREENLEAF AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:843-270-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00024330171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530407Medicaid
TN1530407Medicaid