Provider Demographics
NPI:1821826066
Name:JENKINS, ANDREA CHANEL (MPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHANEL
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 ERNESTINE FALLS
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5517
Mailing Address - Country:US
Mailing Address - Phone:843-801-5558
Mailing Address - Fax:
Practice Address - Street 1:523 ERNESTINE FALLS
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-5517
Practice Address - Country:US
Practice Address - Phone:843-801-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management