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Organization
GRACE T. DUQUE-DIZON, MD, PC
Active
Organization
GRACE T. DUQUE-DIZON, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE T DUQUE DIZON M.D. (OWNER - PRESIDENT)
(478) 621-0905
Entity
Organization
Contact information
Practice address
101 GREENSBORO RD, EATONTON, GA 31024-6054
(478) 621-0905
(478) 742-0854
Mailing address
PO BOX 4207, MACON, GA 31208-4207
(478) 621-0905
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB9533
RAIL ROAD MEDICARE GROUP
GA
Enumeration date
01/02/2007
Last updated
08/22/2020
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