Healthcare Provider Details

I. General information

NPI: 1265425698
Provider Name (Legal Business Name): SCOTT A JENKINSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/25/2022
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOSPITAL DR
ATHENS OH
45701-2302
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 740-566-4530
  • Fax: 740-566-4535
Mailing address:
  • Phone: 614-544-6155
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number34.003705
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number34003705
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: