MEDICARE: MS. DEBBIE DUNBAR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1536	GA

General Provider Information

NPI Number	:	1073514725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBBIE DUNBAR LCSW

Provider Business Mailing Address
First Line	:	2710 JEFFERSON ST
Second Line	:	SUITE 6
City	:	AUSTELL
State	:	GA
Zip	:	30168-4050
Country	:	US
Telephone Number	:	770-732-0190
Fax Number	:	770-732-0333

Provider Business Practice Location Address
First Line	:	2710 JEFFERSON ST
Second Line	:	SUITE 6
City	:	AUSTELL
State	:	GA
Zip	:	30168-4050
Country	:	US
Telephone Number	:	770-732-0190
Fax Number	:	770-732-0333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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