Provider Demographics
NPI:1366477978
Name:JENKINS-MOREE, DAWN (R)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:JENKINS-MOREE
Suffix:
Gender:F
Credentials:R
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R
Mailing Address - Street 1:110 TUPELO CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-4560
Mailing Address - Country:US
Mailing Address - Phone:912-267-0220
Mailing Address - Fax:
Practice Address - Street 1:1699 S 14TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1963
Practice Address - Country:US
Practice Address - Phone:904-491-7700
Practice Address - Fax:904-491-7701
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
287089247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist