Individual
MARIE MAUDE DURANDISSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8954 HOSPITAL DR, DOUGLASVILLE, GA 30134-2272
(470) 644-6000
Mailing address
4710 TUGALO TRL, DOUGLASVILLE, GA 30135-5877
(954) 643-0785
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
232735
GA
207Q00000X
Family Medicine Physician
Primary
232735
GA
207R00000X
Internal Medicine Physician
232735
GA
208D00000X
General Practice Physician
232735
GA
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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