Provider Demographics
NPI:1265496228
Name:JENKINS, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
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 1:300 E WENDOVER AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1229
Mailing Address - Country:US
Mailing Address - Phone:336-663-5038
Mailing Address - Fax:
Practice Address - Street 1:300 E WENDOVER AVE FL 4
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1229
Practice Address - Country:US
Practice Address - Phone:336-663-5038
Practice Address - Fax:336-663-5367
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144OtherPARTNERS MEDICARE
NC4135031OtherAETNA
NC39862OtherMEDCOST
NC45892OtherBCBS NC
NC8945892Medicaid
NC4135031OtherAETNA
NC8945892Medicaid