Healthcare Provider Details

I. General information

NPI: 1013205939
Provider Name (Legal Business Name): ALICIA DUBOISE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 DANNON VW SW STE 3202
ATLANTA GA
30331-2160
US

IV. Provider business mailing address

3665 CLUB DR STE 107
DULUTH GA
30096-1806
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-3471
  • Fax: 404-346-3473
Mailing address:
  • Phone: 678-288-6550
  • Fax: 800-609-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN064076
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: