Provider Demographics
NPI:1295551505
Name:DUB ENTERPRISES
Entity type:Organization
Organization Name:DUB ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-699-2121
Mailing Address - Street 1:2321 WILLOW SHADE LN
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5932
Mailing Address - Country:US
Mailing Address - Phone:678-699-2121
Mailing Address - Fax:
Practice Address - Street 1:2715 LOGANVILLE HWY STE 310
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6661
Practice Address - Country:US
Practice Address - Phone:770-559-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty