Healthcare Provider Details

I. General information

NPI: 1124196928
Provider Name (Legal Business Name): JOSEFINA CATHRYN ABENDAN DUBBERLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E TOLLISON ST STE D
BAXLEY GA
31513-0150
US

IV. Provider business mailing address

PO BOX 2070
BAXLEY GA
31515-2070
US

V. Phone/Fax

Practice location:
  • Phone: 912-366-9688
  • Fax: 912-366-9888
Mailing address:
  • Phone: 912-367-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number057562
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: