Healthcare Provider Details

I. General information

NPI: 1548145592
Provider Name (Legal Business Name): DAVID JENKINS LAPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 CHURCH ST
FLOWERY BRANCH GA
30542-5781
US

IV. Provider business mailing address

430 PRIOR ST NE
GAINESVILLE GA
30501-3441
US

V. Phone/Fax

Practice location:
  • Phone: 678-828-7301
  • Fax:
Mailing address:
  • Phone: 678-971-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010389
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: