MEDICARE: MARCUS JENKINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	D47952	MD
2	207L00000X	Anesthesiology Physician	48058	GA

General Provider Information

NPI Number	:	1194700708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS JENKINS MD

Provider Business Mailing Address
First Line	:	170 LONGCREEK DR
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-1046
Country	:	US
Telephone Number	:	678-817-7494
Fax Number	:	678-817-7495

Provider Business Practice Location Address
First Line	:	170 LONGCREEK DR
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-1046
Country	:	US
Telephone Number	:	678-817-7494
Fax Number	:	678-817-7495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/11/2023

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