Provider Demographics
NPI:1225190507
Name:DUBOSE, DAVID DEWAYNE (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DEWAYNE
Last Name:DUBOSE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:374 SILVERTOP DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4101
Mailing Address - Country:US
Mailing Address - Phone:404-918-0803
Mailing Address - Fax:770-733-1734
Practice Address - Street 1:590 CASCADE AVE SW
Practice Address - Street 2:STE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2467
Practice Address - Country:US
Practice Address - Phone:404-758-8373
Practice Address - Fax:404-758-8372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA003423363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical