MEDICARE: KARENTYN PAIGE 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	2255A2300X	Athletic Trainer		GA
2	390200000X	Student in an Organized Health Care Education/Training Program		GA

General Provider Information

NPI Number	:	1366374118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARENTYN PAIGE JENKINS

Provider Business Mailing Address
First Line	:	2888 BATTLECREST DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-2663
Country	:	US
Telephone Number	:	404-436-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	2888 BATTLECREST DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-2663
Country	:	US
Telephone Number	:	404-436-9903
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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