Provider Demographics
NPI:1487674016
Name:JENKINS, HAL JEFFERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:JEFFERSON
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:PO BOX 1669
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-1669
Mailing Address - Country:US
Mailing Address - Phone:615-672-7122
Mailing Address - Fax:615-672-8122
Practice Address - Street 1:491 SAGE RD N STE 200
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9361
Practice Address - Country:US
Practice Address - Phone:615-672-7122
Practice Address - Fax:615-672-8122
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3890858Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TNI04066Medicare UPIN