Provider Demographics
NPI:1568066116
Name:DUBOIS, MERLE D
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:D
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 ANDREW HAIRSTON PL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-3308
Mailing Address - Country:US
Mailing Address - Phone:678-477-2874
Mailing Address - Fax:
Practice Address - Street 1:254 ANDREW HAIRSTON PL NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-3308
Practice Address - Country:US
Practice Address - Phone:678-477-2874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028858444163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse