Provider Demographics
NPI:1851680904
Name:JENKINS, JEFFREY DAN (DPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DAN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 NASHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3103
Mailing Address - Country:US
Mailing Address - Phone:615-230-9990
Mailing Address - Fax:615-451-6491
Practice Address - Street 1:845 NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3103
Practice Address - Country:US
Practice Address - Phone:615-230-9990
Practice Address - Fax:615-451-6491
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC7919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist