Provider Demographics
NPI:1942399027
Name:DOUBERLY, JENNIFER ALICE (AUD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALICE
Last Name:DOUBERLY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 S MILLEDGE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1823
Mailing Address - Country:US
Mailing Address - Phone:706-850-3691
Mailing Address - Fax:706-609-3443
Practice Address - Street 1:2005 S MILLEDGE AVE STE 105
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1823
Practice Address - Country:US
Practice Address - Phone:706-850-3691
Practice Address - Fax:706-609-3443
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003749231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist