Provider Demographics
NPI:1831182674
Name:DOCKERY, JEFFERY JOE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:JOE
Last Name:DOCKERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BRYAN ST W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4730
Mailing Address - Country:US
Mailing Address - Phone:912-359-3869
Mailing Address - Fax:912-359-2101
Practice Address - Street 1:310 BRYAN ST W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-4730
Practice Address - Country:US
Practice Address - Phone:912-389-4586
Practice Address - Fax:912-389-4590
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00656686CMedicaid
GA08BDJXSMedicare ID - Type Unspecified
GAG05387Medicare UPIN