Individual
TRACY D BLAND DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5440 HILLANDALE DR, DEPARTMENT OF OB GYN, LITHONIA, GA 30058-4865
(770) 322-2716
(770) 322-3244
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 364-7000
(404) 364-4732
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
052865
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58-1397572
FEDERAL TAX ID#
GA
05
—
994626282A
—
GA
Enumeration date
09/09/2005
Last updated
01/13/2022
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