Healthcare Provider Details

I. General information

NPI: 1033029657
Provider Name (Legal Business Name): VONKERIA LANIYA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 CADUCEUS WAY STE 101
WATKINSVILLE GA
30677-7300
US

IV. Provider business mailing address

348 SIMS CROSS RD
STEPHENS GA
30667-1821
US

V. Phone/Fax

Practice location:
  • Phone: 762-499-3476
  • Fax:
Mailing address:
  • Phone: 706-621-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: