Healthcare Provider Details

I. General information

NPI: 1730166489
Provider Name (Legal Business Name): CRAIG MILTON JENKINS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 REILLY RD WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-7324
US

IV. Provider business mailing address

2817 REILLY RD WOMACK ARMY MEDICAL CENTER
FORT BRAGG NC
28310-7324
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-8922
  • Fax: 910-907-6069
Mailing address:
  • Phone: 910-907-8922
  • Fax: 910-907-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1211
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: