Provider Demographics
NPI:1841627551
Name:JENKINS, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150057
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-0180
Mailing Address - Country:US
Mailing Address - Phone:404-397-2228
Mailing Address - Fax:404-622-8887
Practice Address - Street 1:405 GRANT PARK PL SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-1429
Practice Address - Country:US
Practice Address - Phone:404-397-2228
Practice Address - Fax:404-622-8887
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA765705251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8889782OtherNPN NATIONAL PRODUCER NUMBER