Healthcare Provider Details

I. General information

NPI: 1619185337
Provider Name (Legal Business Name): WINIFRED JENKINS SST III, CPRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

IV. Provider business mailing address

735 BLACK OAK DR
COLUMBUS GA
31907-5353
US

V. Phone/Fax

Practice location:
  • Phone: 229-887-3609
  • Fax: 229-887-2285
Mailing address:
  • Phone: 706-565-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: