MEDICARE: DR. COLLIN HARDING DUBICK M.D.

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
1	2080P0208X	Pediatric Infectious Diseases Physician	82346	GA
2	208000000X	Pediatrics Physician	82346	GA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1649632225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLIN HARDING DUBICK M.D.

Provider Business Mailing Address
First Line	:	2174 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3102
Country	:	US
Telephone Number	:	404-785-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	2174 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3102
Country	:	US
Telephone Number	:	404-785-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	05/27/2026

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