Provider Demographics
NPI:1437596095
Name:JENKINS, MARTHA DOROTHY (MASTER DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:DOROTHY
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MASTER DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 BRIGHTON TRL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-8805
Mailing Address - Country:US
Mailing Address - Phone:917-312-3811
Mailing Address - Fax:
Practice Address - Street 1:2498 BRIGHTON TRL
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-8805
Practice Address - Country:US
Practice Address - Phone:917-312-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator