Provider Demographics
NPI:1033918867
Name:DUBOSE, SALLIE WALKER
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:WALKER
Last Name:DUBOSE
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 1:1113 NORRIS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2029
Mailing Address - Country:US
Mailing Address - Phone:803-673-8993
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1090
Practice Address - Street 2:
Practice Address - City:BUIES CREEK
Practice Address - State:NC
Practice Address - Zip Code:27506-1090
Practice Address - Country:US
Practice Address - Phone:910-893-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program