Doctor Name: | MARK JENKINS |
NPI Number: | 1558364810 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 21019 |
Business Practice Address: | 2204 Pavilion Dr Suite 310 Kingsport, TN - 376604657 |
Business Phone Number: | 4232243900 |
Business Fax Number: | 4232243901 |
Mailing Address: | 2204 Pavilion Dr, Suite 310 KINGSPORT |
State: | TN |
Postal Code: | 376604657 |
Phone Number: | 4232243900 |
Fax Number: | 4232243901 |
NPI Enumeration Date: | 05/31/2005 |
NPI Last Update Date: | 10/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 21019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |