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NPI Code Detail

MEDICARE: DR. CHARAY JENNINGS-DOVER M.D., PH.D.

MEDICARE: DR. CHARAY JENNINGS-DOVER M.D., PH.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
1207ZD0900XDermatopathology (Pathology) PhysicianA109084CA

General Provider Information

NPI Number : 1114282076
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARAY JENNINGS-DOVER M.D., PH.D.
Provider Business Mailing Address
First Line : PO BOX 23329
Second Line :
City : NEW YORK
State : NY
Zip : 10087-3329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 LAKE PARK DR SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-7611
Country : US
Telephone Number : 678-556-9411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2012
Last Update Date : 04/13/2026

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