MEDICARE: DR. DON ANTONIO DUBOSE M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	32612	SC
2	2084P0800X	Psychiatry Physician	002561	GA

General Provider Information

NPI Number	:	1336313329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DON ANTONIO DUBOSE M.D.

Provider Business Mailing Address
First Line	:	1911 GADSDEN ST STE 204
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-6400
Country	:	US
Telephone Number	:	803-851-0642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 GADSDEN ST STE 204
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-6400
Country	:	US
Telephone Number	:	803-851-0642
Fax Number	:

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

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	12/06/2016

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