MEDICARE: DR. SHANTAE JAMES JENKINS MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	30021	SC

General Provider Information

NPI Number	:	1194923094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTAE JAMES JENKINS MD, PHD

Provider Business Mailing Address
First Line	:	PO BOX 602108
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2108
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8471 DORCHESTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7381
Country	:	US
Telephone Number	:	843-876-2879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/09/2013

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