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NPI Code Detail

MEDICARE: DONASJA S DUBOSE

MEDICARE: DONASJA S DUBOSE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1184493017
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONASJA S DUBOSE
Provider Business Mailing Address
First Line : 6371 SEYMOUR PL NW
Second Line :
City : ACWORTH
State : GA
Zip : 30101-8063
Country : US
Telephone Number : 614-432-5869
Fax Number :
Provider Business Practice Location Address
First Line : 6371 SEYMOUR PL NW
Second Line :
City : ACWORTH
State : GA
Zip : 30101-8063
Country : US
Telephone Number : 614-432-5869
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2023
Last Update Date : 12/20/2023

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Directions to “ DONASJA S DUBOSE ” Practice Location

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