Provider Demographics
NPI:1821477811
Name:JENKINS, LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15830 BALLANTYNE MEDICAL PL STE 225
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0760
Mailing Address - Country:US
Mailing Address - Phone:704-919-1105
Mailing Address - Fax:704-910-3163
Practice Address - Street 1:15830 BALLANTYNE MEDICAL PL STE 225
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0760
Practice Address - Country:US
Practice Address - Phone:704-919-1105
Practice Address - Fax:704-910-3163
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL38128207R00000X
NC2020-02972207ND0101X
GA8912207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery