Provider Demographics
NPI:1932466257
Name:JENKINS, ASHLEY JANE (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JANE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:JANE
Other - Last Name:SAGMOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 PLAZA CIR STE J
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7559
Mailing Address - Country:US
Mailing Address - Phone:864-547-8300
Mailing Address - Fax:
Practice Address - Street 1:500 PLAZA CIR STE J
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7559
Practice Address - Country:US
Practice Address - Phone:864-547-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC38038208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program