Provider Demographics
NPI:1265418164
Name:DUBOSE, MACDONALD MAYES (MD)
Entity type:Individual
Prefix:
First Name:MACDONALD
Middle Name:MAYES
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:MAYES
Other - Last Name:DUBOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:244 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4256
Mailing Address - Country:US
Mailing Address - Phone:803-775-1001
Mailing Address - Fax:803-774-1012
Practice Address - Street 1:244 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4256
Practice Address - Country:US
Practice Address - Phone:803-775-1001
Practice Address - Fax:803-774-1012
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22541207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225412Medicaid
SCH67520Medicare UPIN
SC225412Medicaid