Healthcare Provider Details

I. General information

NPI: 1265418164
Provider Name (Legal Business Name): MACDONALD MAYES DUBOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: M MAYES DUBOSE M.D.

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 CHURCH ST
SUMTER SC
29150-4256
US

IV. Provider business mailing address

244 CHURCH ST
SUMTER SC
29150-4256
US

V. Phone/Fax

Practice location:
  • Phone: 803-775-1001
  • Fax: 803-774-1012
Mailing address:
  • Phone: 803-775-1001
  • Fax: 803-774-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number22541
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: