Individual
DUANE L PRICKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SA-C, RSA, LSA
Contact information
Practice address
1579 MONROE DR NE STE F, ATLANTA, GA 30324-5022
(404) 788-1321
Mailing address
1579 MONROE DR NE STE F, UNIT 711, ATLANTA, GA 30324-5022
(404) 788-1321
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
02-151
GA
363AS0400X
Surgical Physician Assistant
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02-151
SURGICAL ASSISTANT-CERTIFIED
—
01
—
238.000307
REGISTRATION
IL
01
—
SA.0001689
COLORADO STATE LICENSE
CO
Enumeration date
01/04/2007
Last updated
12/05/2013
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