Provider Demographics
NPI:1730112723
Name:DUBOSE, PHILIP JAMES JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JAMES
Last Name:DUBOSE
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:920 US HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-0510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 OLD ALBANY RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4014
Practice Address - Country:US
Practice Address - Phone:229-228-8100
Practice Address - Fax:229-228-8154
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY002549103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00923007BMedicaid
GA68BBFZGMedicare ID - Type Unspecified