Individual
DR. MATTHEW T JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1118 ROSS CLARK CIR, DOTHAN, AL 36301-3001
(334) 793-5105
Mailing address
1118 ROSS CLARK CIR, SUITE 700 ANESTHESIA CONSULTANTS MEDICAL GROUP PC, DOTHAN, AL 36301-3001
(334) 793-5105
(334) 671-5073
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0768
AL
207LP2900X
Pain Medicine (Anesthesiology) Physician
D0768
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009994565
—
AL
01
—
018824088A
GEORGIA MEDICAID
—
01
—
51528444
BCBS OF AL
—
Enumeration date
01/10/2006
Last updated
04/25/2011
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