Healthcare Provider Details

I. General information

NPI: 1043218878
Provider Name (Legal Business Name): JOHN A DENNIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N JEFFERSON ST
ALBANY GA
31701-2057
US

IV. Provider business mailing address

1200 N JEFFERSON ST
ALBANY GA
31701-2057
US

V. Phone/Fax

Practice location:
  • Phone: 229-888-3970
  • Fax: 229-888-7771
Mailing address:
  • Phone: 229-888-3970
  • Fax: 229-888-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003748
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: