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General NPI Number Information
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NPI Number | 1225190507
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Entity Type | Individual
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Provider Name | DAVID DEWAYNE DUBOSE PA
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 590 CASCADE AVE SW STE 400
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City | ATLANTA
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State | GA
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Zip | 30310-2467
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Country | US
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Telephone | 404-758-8373
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Fax | 404-758-8372
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Provider Business Mailing Address
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Address Line | 374 SILVERTOP DR
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City | GRAYSON
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State | GA
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Zip | 30017-4101
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Country | US
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Telephone | 404-918-0803
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Fax | 770-733-1734
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 003423
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License Number State | GA
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