Provider Demographics
NPI:1003806274
Name:JENKINS, CHRISTOPHER LACY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LACY
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 AZALEA RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1516
Mailing Address - Country:US
Mailing Address - Phone:251-665-5360
Mailing Address - Fax:251-665-5361
Practice Address - Street 1:576 AZALEA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1516
Practice Address - Country:US
Practice Address - Phone:251-665-5360
Practice Address - Fax:251-665-5361
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000217362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4479981OtherCIGNA
AL51550204OtherBCBS AL
AL051550204Medicaid
ALAETNAOther7957202
ALAETNAOther7957202
AL051550204Medicare ID - Type Unspecified
AL051550204Medicaid