Provider Demographics
NPI:1548157043
Name:JENKINS, WILLIAM A JR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 GARFIELD AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-1220
Mailing Address - Country:US
Mailing Address - Phone:330-323-8352
Mailing Address - Fax:
Practice Address - Street 1:807 GARFIELD AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-1220
Practice Address - Country:US
Practice Address - Phone:330-323-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker