Provider Demographics
NPI:1114282076
Name:JENNINGS-DOVER, CHARAY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARAY
Middle Name:
Last Name:JENNINGS-DOVER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:CHARAY
Other - Middle Name:D
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:2000 LAKE PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7611
Mailing Address - Country:US
Mailing Address - Phone:678-556-5411
Mailing Address - Fax:
Practice Address - Street 1:2000 LAKE PARK DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7611
Practice Address - Country:US
Practice Address - Phone:678-556-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109084207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology