Melissa Jenkins
Individual provider Active NPI Contractor · Quitman, GA
NPI 1083163232 · NPPES record last updated Sep 29, 2016
Key facts
- NPI
- 1083163232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 586 (GA)
- Practice address
- 136 Rosa LN
Quitman, GA 31643-3680 - Phone
- (229) 561-2099
- NPI assigned
- Sep 29, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 586 | GA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 586 | GA | Yes |
Addresses
Primary practice location
136 Rosa LN
Quitman, GA 31643-3680
Mailing address
136 Rosa Lane
Quitman, GA 31643
Phone (229) 561-2099
Other providers in Quitman, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.