Healthcare Provider Details

I. General information

NPI: 1326969049
Provider Name (Legal Business Name): MASON GABRIEL DUBOSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD
SANDY SPRINGS GA
30342-1701
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD
SANDY SPRINGS GA
30342-1764
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-7001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: