Provider Demographics
NPI:1093267312
Name:JENKINS, RENA
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 557
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7343
Mailing Address - Country:US
Mailing Address - Phone:770-285-8781
Mailing Address - Fax:866-451-4970
Practice Address - Street 1:235 PEACHTREE ST NE
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1401
Practice Address - Country:US
Practice Address - Phone:770-285-8781
Practice Address - Fax:866-451-4970
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)