Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35078360 | OH |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 79451 | GA |
NPI | 1033111000 |
---|---|
Provider Name | Oliver H Jenkins |
First Address | Jesup, GA 31545-0244 |
Second Address | Jesup, GA 31545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 02/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2181035 | (05) | OH |
G81532 | (02) | OH |
P00081655 | RRMC (01) | OH |