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NPI Code Detail

MEDICARE: SANDRA ELAINE DUBOSE FNP

MEDICARE: SANDRA ELAINE DUBOSE FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner129SC
2363LF0000XFamily Nurse PractitionerRN103532GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548264047
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA ELAINE DUBOSE FNP
Provider Business Mailing Address
First Line : PO BOX 740015
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0015
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 1631 GORDON HWY STE 17A
Second Line :
City : AUGUSTA
State : GA
Zip : 30906-2229
Country : US
Telephone Number : 706-230-7006
Fax Number : 762-257-7442
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 03/19/2024

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Directions to “ SANDRA ELAINE DUBOSE FNP” Practice Location

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