Individual provider Active NPI

Herndon Anthony Durett II

  • Audiologist
  • Dalton, GA
National Provider Identifier
1649438714
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
003792 Issued in GA
Practice address
1011 Professional Blvd
Dalton, GA 30720-2506
Phone
(706) 226-4623
Fax
(706) 278-0580
NPI assigned
May 27, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 003792 GA Primary

Addresses

Primary practice location

1011 Professional Blvd
Dalton, GA 30720-2506

Mailing address

1011 Professional Blvd
Dalton, GA 30720-2506
Phone (706) 226-4623

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
003792GAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Audiology Distribution, LLC CurrentSince Oct 1, 2024 Accepting new patients
Galen Medical Group, PC PastSince Oct 1, 2015 Accepting new patients

Locations

1502 W 3rd Ave
Albany, GA 31707
Phone (229) 434-0003

1437 Riverstone Pkwy
Ste 105
Canton, GA 30114
Phone (404) 400-5970

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1649438714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 PROFESSIONAL BLVD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202506",
            "telephone_number": "706-226-4623",
            "fax_number": "706-278-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 PROFESSIONAL BLVD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202506",
            "telephone_number": "706-226-4623",
            "fax_number": "706-278-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURETT",
        "first_name": "HERNDON",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-27",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "GA",
            "license": "003792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.