Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 030627 | GA |
NPI | 1003859455 |
---|---|
Provider Name | Dr. Jeffrey S Jenkins |
First Address | Columbus, GA 31902-1038 |
Second Address | Columbus, GA 31901-3700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 22/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19613 | (02) |