Provider Demographics
NPI:1851444319
Name:JENKINS, LONNIE CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:CHARLES
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10051 5TH STREET NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:SUITE 516
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1200
Practice Address - Country:US
Practice Address - Phone:404-265-1235
Practice Address - Fax:404-265-1217
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA017209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000184324AMedicaid
D40259Medicare UPIN
GAD40259Medicare UPIN