Healthcare Provider Details

I. General information

NPI: 1932986494
Provider Name (Legal Business Name): JASMINE D DUBOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 VELTRE TER SW
ATLANTA GA
30311-3144
US

IV. Provider business mailing address

2715 VELTRE TER SW
ATLANTA GA
30311-3144
US

V. Phone/Fax

Practice location:
  • Phone: 205-253-0115
  • Fax:
Mailing address:
  • Phone: 205-253-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number23061457
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number23061457
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: