Individual
JENNIFER DOROUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
400 CHARTER BLVD, MACON, GA 31210-4831
(478) 757-8200
Mailing address
4806 GUERRY DR, MACON, GA 31210-4104
(478) 320-3480
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN200221
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN200221
ADVANCED PRACTICE NP
GA
Enumeration date
09/19/2018
Last updated
09/19/2018
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