Organization
ATLANTA METRO UROLOGY CLINICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FERNANDO A DURALDE M.D. (PRESIDENT)
(770) 716-9656
Entity
Organization
Contact information
Practice address
1275 HIGHWAY 54 W, SUITE 205, FAYETTEVILLE, GA 30214-4549
(770) 716-9656
(770) 716-1609
Mailing address
1275 HIGHWAY 54 W, SUITE 205, FAYETTEVILLE, GA 30214-4549
(770) 716-9656
(770) 716-1609
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55002145A
—
GA
01
—
CN9719
RAILROAD MEDICARE
GA
Enumeration date
10/10/2006
Last updated
03/13/2008
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