Provider Demographics
NPI:1336164482
Name:JENKINS, TODD
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19350207VM0101X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G78277OtherVIVA
AL009943178Medicaid
AL051541276OtherBLUE CROSS BLUE SHIELD OF
AL009910717Medicaid
AL051541279OtherBLUE CROSS BLUE SHIELD OF
NC89131000000Medicaid
AL009943179Medicaid
AL051541278OtherBLUE CROSS BLUE SHIELD OF
AL051541277OtherBLUE CROSS BLUE SHIELD OF
AL051542334OtherBLUE CROSS BLUE SHIELD OF
AL009943177Medicaid
G78277OtherVIVA
NCG78277Medicare UPIN
NC2006978Medicare ID - Type Unspecified
AL009943179Medicaid