Healthcare Provider Details

I. General information

NPI: 1821131533
Provider Name (Legal Business Name): WILLIAM R JENKINS JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W FRANKLIN ST
SYLVESTER GA
31791-7174
US

IV. Provider business mailing address

PO BOX 846
SYLVESTER GA
31791-0846
US

V. Phone/Fax

Practice location:
  • Phone: 229-821-3892
  • Fax: 229-821-3893
Mailing address:
  • Phone: 229-821-3892
  • Fax: 229-821-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002447
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: