Healthcare Provider Details

I. General information

NPI: 1750182051
Provider Name (Legal Business Name): JOSEPH DAVID JENKINS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 GLENWOOD AVE SE APT 601
ATLANTA GA
30316-2097
US

IV. Provider business mailing address

860 GLENWOOD AVE SE APT 601
ATLANTA GA
30316-2097
US

V. Phone/Fax

Practice location:
  • Phone: 404-312-4882
  • Fax:
Mailing address:
  • Phone: 404-312-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP298354
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP298354
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN298354
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN298354
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: