MEDICARE: JAMES EDWARD 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	2084P0800X	Psychiatry Physician	9864	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120579630	OTHER	SC	ORGANIZATION NPI
2	571128621	OTHER	SC	TAX ID

General Provider Information

NPI Number	:	1861499816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD JENKINS MD

Provider Business Mailing Address
First Line	:	3300 WEST MONTAGUE AVE
Second Line	:	SUITE 203
City	:	N. CHARLESTON
State	:	SC
Zip	:	29418
Country	:	US
Telephone Number	:	843-740-6999
Fax Number	:	843-740-5433

Provider Business Practice Location Address
First Line	:	3300 WEST MONTAGUE AVE
Second Line	:	SUITE 203
City	:	N. CHARLESTON
State	:	SC
Zip	:	29418
Country	:	US
Telephone Number	:	843-740-6999
Fax Number	:	843-740-5433

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	03/26/2014

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