Provider Demographics
NPI:1518792332
Name:DUBOIS INTEGRITY ACADEMY
Entity type:Organization
Organization Name:DUBOIS INTEGRITY ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:470-923-1834
Mailing Address - Street 1:749 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2398
Mailing Address - Country:US
Mailing Address - Phone:470-923-1834
Mailing Address - Fax:
Practice Address - Street 1:749 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2398
Practice Address - Country:US
Practice Address - Phone:770-629-1235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty