Provider Demographics
NPI:1043218878
Name:DENNIS, JOHN A (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:DENNIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2057
Mailing Address - Country:US
Mailing Address - Phone:229-888-3970
Mailing Address - Fax:229-888-7771
Practice Address - Street 1:1200 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2057
Practice Address - Country:US
Practice Address - Phone:229-888-3970
Practice Address - Fax:229-888-7771
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003748363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA548030581AMedicaid
GA548030581CMedicaid
GA548030581EMedicaid
GA548030581MMedicaid
GA548030581TMedicaid
GA548030581XMedicaid
GA548030581HMedicaid
GA548030581IMedicaid
GA548030581VMedicaid
GA548030581BMedicaid
GA548030581YMedicaid
GA548030581RMedicaid
GA548030581WMedicaid
GA548030581UMedicaid
GA548030581JMedicaid
GA548030581IMedicaid
GA548030581AMedicaid