Provider Demographics
NPI:1689743569
Name:JENKINS-ALFORD, ELEANOR RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:RENEE
Last Name:JENKINS-ALFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1005 BAKERS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-3096
Mailing Address - Country:US
Mailing Address - Phone:843-207-9144
Mailing Address - Fax:
Practice Address - Street 1:122 S GOOSE CREEK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3136
Practice Address - Country:US
Practice Address - Phone:843-553-2211
Practice Address - Fax:843-553-2210
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC16242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF41158Medicare UPIN