Provider Demographics
NPI:1487634705
Name:JENKINS, JOEL CHANDLER (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:CHANDLER
Last Name:JENKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 PRINCE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2764
Mailing Address - Country:US
Mailing Address - Phone:706-353-2520
Mailing Address - Fax:706-353-2584
Practice Address - Street 1:850 PRINCE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2764
Practice Address - Country:US
Practice Address - Phone:706-353-2520
Practice Address - Fax:706-353-2584
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA762696739AMedicaid
GA762696739AMedicaid