Provider Demographics
NPI:1831202951
Name:JENKINS, SUSANNAH MARGARET (PA-C)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:MARGARET
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3129
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3129
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:630 13TH STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1017
Practice Address - Country:US
Practice Address - Phone:706-724-2500
Practice Address - Fax:706-823-5928
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004832363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0505PAMedicaid
GA004832OtherGA LICENSE
GA202I970489Medicare PIN