Provider Demographics
NPI:1245867795
Name:JENKINS, MELISSA CAROL (CASE MANAGEMENT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAROL
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CASE MANAGEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HILL RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-4450
Mailing Address - Country:US
Mailing Address - Phone:912-246-5339
Mailing Address - Fax:912-565-7761
Practice Address - Street 1:154 HILL RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-4450
Practice Address - Country:US
Practice Address - Phone:912-246-5339
Practice Address - Fax:912-565-7761
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management