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Individual

LAUREN M DUBBERLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
948 S MAIN ST, BAXLEY, GA 31513-0138
(502) 663-3326
Mailing address
948 S MAIN ST, BAXLEY, GA 31513-0138
(502) 663-3326

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
007777
GA
363A00000X
Physician Assistant
10001333A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201125230
IN
Enumeration date
11/17/2011
Last updated
12/14/2015
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