Individual
MR. PHILLIP THORNTON DURST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1022 WELLESLEY CREST DR, WOODSTOCK, GA 30189-6710
(678) 494-4074
Mailing address
1022 WELLESLEY CREST DR, WOODSTOCK, GA 30189-6710
(678) 494-4074
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN038761 CRNA
GA
Other
Enumeration date
06/17/2007
Last updated
07/08/2007
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