Provider Demographics
NPI:1669609442
Name:PENN, DOLLY CHANTA'E (MD, MSCR)
Entity type:Individual
Prefix:
First Name:DOLLY
Middle Name:CHANTA'E
Last Name:PENN
Suffix:
Gender:F
Credentials:MD, MSCR
Other - Prefix:
Other - First Name:DOLLY
Other - Middle Name:PENN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MSCR
Mailing Address - Street 1:6707 DEMOCRACY BLVD SUITE 800
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-5465
Mailing Address - Country:US
Mailing Address - Phone:301-496-8676
Mailing Address - Fax:
Practice Address - Street 1:111 MOUNTAIN BROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9045
Practice Address - Country:US
Practice Address - Phone:678-880-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81812208D00000X, 2083P0901X
MDD813352083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice