Provider Demographics
NPI:1518859768
Name:DUBAY, TATUM
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:
Last Name:DUBAY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 HAMPTON BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3073
Mailing Address - Country:US
Mailing Address - Phone:303-502-4292
Mailing Address - Fax:303-502-4292
Practice Address - Street 1:945 HAMPTON BLUFF DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-3073
Practice Address - Country:US
Practice Address - Phone:303-502-4292
Practice Address - Fax:303-502-4292
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist