Provider Demographics
NPI:1811578248
Name:DOUGLASS, DEBORAH R
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:DOUGLASS
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 1:6828 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2495
Mailing Address - Country:US
Mailing Address - Phone:336-442-5550
Mailing Address - Fax:
Practice Address - Street 1:6828 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-2495
Practice Address - Country:US
Practice Address - Phone:336-442-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health