Healthcare Provider Details

I. General information

NPI: 1184814519
Provider Name (Legal Business Name): BONNIE P JENKINS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DOGWOOD DRIVE
WAYNESBORO GA
30830
US

IV. Provider business mailing address

201 DOGWOOD DRIVE
WAYNESBORO GA
30830
US

V. Phone/Fax

Practice location:
  • Phone: 706-437-0046
  • Fax: 706-437-0546
Mailing address:
  • Phone: 706-437-0046
  • Fax: 706-437-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIE G RADFORD
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-437-0046