Provider Demographics
NPI:1184814519
Name:BONNIE P JENKINS MD PC
Entity Type:Organization
Organization Name:BONNIE P JENKINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-437-0046
Mailing Address - Street 1:201 DOGWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830
Mailing Address - Country:US
Mailing Address - Phone:706-437-0046
Mailing Address - Fax:706-437-0046
Practice Address - Street 1:201 DOGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830
Practice Address - Country:US
Practice Address - Phone:706-437-0046
Practice Address - Fax:706-437-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4701Medicare PIN