Individual
CHARLES JACOB DOUCHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3850 PLEASANT HILL RD, DULUTH, GA 30096-4807
(770) 814-8222
(678) 205-5111
Mailing address
3850 PLEASANT HILL RD, DULUTH, GA 30096-4807
(770) 814-8222
(678) 205-5111
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
040052
GA
207ND0900X
Dermatopathology Physician
040052
GA
207NS0135X
Procedural Dermatology Physician
040052
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000663396E
—
GA
05
—
000663396F
—
GA
05
—
00663396B
—
GA
01
—
070014632
RR MEDICARE
GA
01
—
2498075
AETNA
GA
01
—
912915
BCBS
GA
Enumeration date
08/22/2005
Last updated
10/02/2015
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