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General NPI Number Information
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NPI Number | 1417113424
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Entity Type | Organization
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Legal Business Name | MARK A. JENKINS, MD
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 1818 RICHARDSON DR SUITE E
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City | REIDSVILLE
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State | NC
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Zip | 27320-5451
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Country | US
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Telephone | 336-634-0095
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Fax | 336-616-0320
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Provider Business Mailing Address
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Address Line | 1818 RICHARDSON DR SUITE E
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City | REIDSVILLE
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State | NC
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Zip | 27320-5451
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Country | US
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Telephone | 336-634-0095
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Fax | 336-616-0320
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK A JENKINS
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Credential | M.D.
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Telephone | 336-634-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9400533
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License Number State | NC
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