Provider Demographics
NPI:1831157940
Name:JENKINS, SPENCER JAMES (MD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:JAMES
Last Name:JENKINS
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 1:1520 TAYLOR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2919
Mailing Address - Country:US
Mailing Address - Phone:803-509-5710
Mailing Address - Fax:803-509-5711
Practice Address - Street 1:1520 TAYLOR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2919
Practice Address - Country:US
Practice Address - Phone:803-509-5710
Practice Address - Fax:803-509-5711
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19796207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5735Medicaid
SCGP5735Medicaid
SCA270Medicare PIN
SCH86258Medicare UPIN