Individual
JACQUELINE DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 15TH ST, HB-3018, AUGUSTA, GA 30912-0004
(706) 721-4588
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2602
(706) 724-6100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
061420
GA
207Q00000X
Family Medicine Physician
TL31805
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061420
STATE
GA
01
—
31805
STATE
SC
Enumeration date
04/02/2007
Last updated
04/27/2011
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