Provider Demographics
NPI:1841293941
Name:JENKINS, JESSE J III (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:J
Last Name:JENKINS
Suffix:III
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 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MAIL STOP 250
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-6304
Mailing Address - Fax:901-595-3100
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:MAIL STOP 250
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-6304
Practice Address - Fax:901-595-3100
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16483207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0030716Medicaid
IA0527671Medicaid
MI104677796Medicaid
IN200179700AMedicaid
AR132315001Medicaid
OH2000631Medicaid
ME422400000Medicaid
MS00117968Medicaid
MT0071944Medicaid
AL009912870Medicaid
OK100033050AMedicaid
MO205140304Medicaid
TN3808768Medicaid
LA1429694Medicaid
KY64926843Medicaid
NC7612397Medicaid
OK100033050AMedicaid
KY64926843Medicaid
LA1429694Medicaid