Provider Demographics
NPI:1861443665
Name:JENKINS, MARK A (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:JENKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4425 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3637
Mailing Address - Country:US
Mailing Address - Phone:912-355-6615
Mailing Address - Fax:912-351-0645
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3637
Practice Address - Country:US
Practice Address - Phone:912-355-6615
Practice Address - Fax:912-351-0645
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050027207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000904329AMedicaid
20041000OtherRAILROAD MEDICARE
H14637Medicare UPIN
GA000904329AMedicaid
GA4954440002Medicare NSC