Individual
DR. GRACE DUQUE-DIZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3356 VINEVILLE AVE, MACON, GA 31204-2328
(478) 476-9642
(478) 476-9976
Mailing address
3356 VINEVILLE AVE, MACON, GA 31204-2328
(478) 476-9642
(478) 476-9976
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
019935
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000412244K
—
GA
Enumeration date
12/22/2005
Last updated
11/30/2009
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