Provider Demographics
NPI:1013205939
Name:DUBOISE, ALICIA (LPN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DUBOISE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 CLUB DR
Mailing Address - Street 2:STE 107
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1806
Mailing Address - Country:US
Mailing Address - Phone:678-288-6550
Mailing Address - Fax:800-609-0965
Practice Address - Street 1:950 DANNON VW SW
Practice Address - Street 2:STE 3202
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2160
Practice Address - Country:US
Practice Address - Phone:404-346-3471
Practice Address - Fax:404-346-3473
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN064076164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse