MEDICARE: WENDY ELIZABETH JENKINS

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	363L00000X	Nurse Practitioner	RN290351	GA

General Provider Information

NPI Number	:	1326910142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY ELIZABETH JENKINS

Provider Business Mailing Address
First Line	:	115 CHABLIS CT
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 GLENLAKE PKWY STE 420
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3489
Country	:	US
Telephone Number	:	404-595-2210
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	11/03/2025

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