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1003808361

NPI Code Detail

MEDICARE: CHARLES JACOB DOUCHY M.D.

MEDICARE: CHARLES JACOB DOUCHY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	040052	GA
2	207ND0900X	Dermatopathology Physician	040052	GA
3	207NS0135X	Procedural Dermatology Physician	040052	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	070014632	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2498075	OTHER	GA	AETNA
3	912915	OTHER	GA	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003808361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES JACOB DOUCHY M.D.

Provider Business Mailing Address
First Line	:	3850 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4807
Country	:	US
Telephone Number	:	770-814-8222
Fax Number	:	678-205-5111

Provider Business Practice Location Address
First Line	:	3850 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4807
Country	:	US
Telephone Number	:	770-814-8222
Fax Number	:	678-205-5111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	10/02/2015

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Directions to “ CHARLES JACOB DOUCHY M.D.” Practice Location

Language	Start Address	Practice Location

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