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1558359398

NPI Code Detail

MEDICARE: CHARLES A JENNINGS MD

MEDICARE: CHARLES A JENNINGS MD

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	207R00000X	Internal Medicine Physician	N6962	AR

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558359398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A JENNINGS MD

Provider Business Mailing Address
First Line	:	PO BOX 402319
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-2319
Country	:	US
Telephone Number	:	479-709-7399
Fax Number	:	479-709-7053

Provider Business Practice Location Address
First Line	:	1120 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5136
Country	:	US
Telephone Number	:	479-709-7260
Fax Number	:	479-709-7261

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	09/16/2010

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Directions to “ CHARLES A JENNINGS MD” Practice Location

Language	Start Address	Practice Location

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