Provider Demographics
NPI:1477671311
Name:JENKINS, JOHANNA BROOKS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:BROOKS
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5790 GARBER DR NE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5102
Mailing Address - Country:US
Mailing Address - Phone:404-252-5553
Mailing Address - Fax:
Practice Address - Street 1:750 HAMMOND DR NE
Practice Address - Street 2:BLDG. 15, SUITE 100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5532
Practice Address - Country:US
Practice Address - Phone:770-671-0400
Practice Address - Fax:404-420-2457
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0119971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics