Individual
JEREMY BROCKFORD DUREL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
(912) 354-3510
Mailing address
PO BOX 116324, ATLANTA, GA 30368-2032
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R130642
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I430853
MEDICARE PTAN
GA
05
—
244337472A
—
GA
05
—
436203900
—
MD
Enumeration date
06/11/2006
Last updated
01/10/2011
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