Healthcare Provider Details

I. General information

NPI: 1275959959
Provider Name (Legal Business Name): HERBERT DUNBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3096 MONTAUK HILL DR
BUFORD GA
30519-8623
US

IV. Provider business mailing address

3096 MONTAUK HILL DR
BUFORD GA
30519-8623
US

V. Phone/Fax

Practice location:
  • Phone: 678-520-5423
  • Fax:
Mailing address:
  • Phone: 678-520-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number06588
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: