Provider Demographics
NPI:1861499816
Name:JENKINS, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEST MONTAGUE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:N. CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418
Mailing Address - Country:US
Mailing Address - Phone:843-740-6999
Mailing Address - Fax:843-740-5433
Practice Address - Street 1:3300 WEST MONTAGUE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:N. CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418
Practice Address - Country:US
Practice Address - Phone:843-740-6999
Practice Address - Fax:843-740-5433
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC120579630OtherORGANIZATION NPI
SC571128621OtherTAX ID
SC7509Medicare PIN
SC571128621OtherTAX ID