MEDICARE: MRS. FELICIA JONES JENKINS LPC

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	101YP2500X	Professional Counselor	02619	GA

General Provider Information

NPI Number	:	1316066673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FELICIA JONES JENKINS LPC

Provider Business Mailing Address
First Line	:	212 BROOKINGS LN
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-6647
Country	:	US
Telephone Number	:	404-761-0980
Fax Number	:	404-761-0720

Provider Business Practice Location Address
First Line	:	5538 OLD NATIONAL HWY
Second Line	:	350
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-3278
Country	:	US
Telephone Number	:	404-761-0980
Fax Number	:	404-761-0720

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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