Basic Information
| Provider Information | |||||||||
| NPI: | 1255322848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUBOVSKY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MB CHB, FCP ( SA ) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 JOHNSON FERRY RD NE | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044191140 | ||||||||
| FaxNumber: | 4044191164 | ||||||||
| Practice Location | |||||||||
| Address1: | 5670 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048512330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 29866 | GA | N | Other Service Providers | Specialist | 207RH0003X | 029866 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00365736A | 05 | GA | MEDICAID |