Healthcare Provider Details

I. General information

NPI: 1407923089
Provider Name (Legal Business Name): DUBLIN MULTISPECIALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL DR SUITE 100 & 200
DUBLIN GA
31021
US

IV. Provider business mailing address

100 MEDICAL DR SUITE 100 & 200
DUBLIN GA
31021
US

V. Phone/Fax

Practice location:
  • Phone: 478-274-8886
  • Fax: 478-274-8887
Mailing address:
  • Phone: 478-274-8886
  • Fax: 478-274-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MANDI SINGLETARY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 478-274-8886