Provider Demographics
NPI:1255779351
Name:MCJENKIN, KRISTOPHER K (MD)
Entity type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:K
Last Name:MCJENKIN
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 1:535 COLISEUM DR STE B
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-0106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 BASS PLANTATION DR
Practice Address - Street 2:APT 607
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5735
Practice Address - Country:US
Practice Address - Phone:770-355-2152
Practice Address - Fax:770-355-2152
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine