Provider Demographics
NPI:1245444009
Name:CHRISTOPHER L. JENKINS, M.D., L.L.C.
Entity type:Organization
Organization Name:CHRISTOPHER L. JENKINS, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LACY
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-650-5360
Mailing Address - Street 1:576 AZALEA RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1516
Mailing Address - Country:US
Mailing Address - Phone:251-665-5360
Mailing Address - Fax:251-665-5361
Practice Address - Street 1:576 AZALEA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1516
Practice Address - Country:US
Practice Address - Phone:251-665-5360
Practice Address - Fax:251-665-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL217362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550204Medicaid
ALF18383Medicare UPIN
AL051550204Medicare ID - Type Unspecified
AL051550204Medicaid