Healthcare Provider Details

I. General information

NPI: 1033111000
Provider Name (Legal Business Name): OLIVER H JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PEACHTREE ST
JESUP GA
31545
US

IV. Provider business mailing address

320 PEACHTREE ST
JESUP GA
31545-0244
US

V. Phone/Fax

Practice location:
  • Phone: 912-427-7790
  • Fax: 912-427-7707
Mailing address:
  • Phone: 912-427-7790
  • Fax: 912-427-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35078360
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number79451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: