Provider Demographics
NPI:1841516630
Name:JENKINS, CHARLES III (APRN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:JENKINS
Suffix:III
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 GOVERNORS DR
Mailing Address - Street 2:SUITE 409
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6101
Mailing Address - Country:US
Mailing Address - Phone:404-366-3647
Mailing Address - Fax:404-366-3648
Practice Address - Street 1:4390 GOVERNORS DRIVE
Practice Address - Street 2:SUITE 409
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6101
Practice Address - Country:US
Practice Address - Phone:404-366-3647
Practice Address - Fax:404-366-3648
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN143268NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily