Healthcare Provider Details

I. General information

NPI: 1255996401
Provider Name (Legal Business Name): CHRISTIANA JEUKENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

1725 SPRING HILL AVE
MOBILE AL
36604-1402
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-7289
  • Fax:
Mailing address:
  • Phone: 251-435-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45147
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: