Healthcare Provider Details

I. General information

NPI: 1831202951
Provider Name (Legal Business Name): SUSANNAH MARGARET JENKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 13TH STREET SUITE 250
AUGUSTA GA
30901-1017
US

IV. Provider business mailing address

P.O. BOX 3129
AUGUSTA GA
30914-3129
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-2500
  • Fax: 706-823-5928
Mailing address:
  • Phone: 706-737-4575
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004832
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: