MEDICARE: AUTUMN RAIN RUSSELL 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1811668155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN RAIN RUSSELL JENKINS

Provider Business Mailing Address
First Line	:	306 N MAIN ST STE 1A
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-2562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4016
Country	:	US
Telephone Number	:	843-588-5677
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	05/27/2026

Similar Medicare Providers

1700943644 — ROPER HOSPITAL INC
Practice Location Address:

7832 RIVERS AVE
NORTH CHARLESTON, SC
29406-4016

Practice Phone: 843-824-8733
Practice Fax: 843-824-2482

1972270908 — EYEMART EXPRESS LLC
Practice Location Address:

7818 RIVERS AVE
NORTH CHARLESTON, SC
29406-4016

Practice Phone: 843-790-2605
Practice Fax:

1063454254 — HIGHLAND PARK CVS LLC
Practice Location Address:

1316 CHARLESTON AVE
MATTOON, IL
61938-4016

Practice Phone: 217-258-2920
Practice Fax:

1982633509 — TONY E RICHARDS R.PH.
Practice Location Address:

1316 CHARLESTON AVE
MATTOON, IL
61938-4016

Practice Phone: 217-258-2920
Practice Fax: 217-235-4190

1659483303 — MRS. JUDY G LATTA M.S.
Practice Location Address:

1300 CHARLESTON AVE
MATTOON, IL
61938-4016

Practice Phone: 217-234-6405
Practice Fax: 217-258-6136

1790853265 — MRS. ELIZABETH MCQUEEN B.A.
Practice Location Address:

1300 CHARLESTON AVE
MATTOON, IL
61938-4016

Practice Phone: 217-234-6405
Practice Fax: 217-258-6136

Directions to “ AUTUMN RAIN RUSSELL JENKINS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.