Healthcare Provider Details

I. General information

NPI: 1265229181
Provider Name (Legal Business Name): ELEONORA JENKINS DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 TOBACCO RD
HEPHZIBAH GA
30815-9014
US

IV. Provider business mailing address

10 BURTON HILLS BLVD STE 400
NASHVILLE TN
37215-3004
US

V. Phone/Fax

Practice location:
  • Phone: 706-771-7001
  • Fax:
Mailing address:
  • Phone: 912-270-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HILLARY HARRIS
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 912-270-0920