Organization
GINA R DURANT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINA RUTH DURANT O.D. (OWNER)
(478) 625-7605
Entity
Organization
Contact information
Practice address
144 E BROAD ST, LOUISVILLE, GA 30434-1620
(478) 625-7605
(478) 625-7605
Mailing address
144 E BROAD ST, LOUISVILLE, GA 30434-1620
(478) 625-7605
(478) 625-7605
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1272-T
GA
152W00000X
Optometrist
1273-T
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000479674B
—
GA
05
—
00515193B
—
GA
Enumeration date
07/03/2007
Last updated
02/20/2013
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