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General NPI Number Information
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NPI Number | 1740263235
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Entity Type | Individual
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Provider Name | WILBERT CARL JENKINS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 2123 GRAMERCY PARK DR
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City | GREENSBORO
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State | NC
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Zip | 27406-8571
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Country | US
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Telephone | 912-572-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 GRAMERCY PARK DR
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City | GREENSBORO
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State | NC
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Zip | 27406-8571
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Country | US
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Telephone | 912-727-5107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 044498
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License Number State | GA
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