Healthcare Provider Details

I. General information

NPI: 1316515232
Provider Name (Legal Business Name): MATTHEW DAVID JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N FANT ST
ANDERSON SC
29621-5708
US

IV. Provider business mailing address

800 N FANT ST
ANDERSON SC
29621-5708
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-2373
  • Fax: 864-512-2020
Mailing address:
  • Phone: 864-512-2373
  • Fax: 864-512-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number97561
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: