Provider Demographics
NPI:1750180964
Name:JENKINS, MADISON SHEA (RD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:SHEA
Last Name:JENKINS
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 CROSSBRIDGE ALY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7561
Mailing Address - Country:US
Mailing Address - Phone:615-691-1171
Mailing Address - Fax:
Practice Address - Street 1:3620 HOWELL FERRY RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3178
Practice Address - Country:US
Practice Address - Phone:678-312-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006638133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered