Individual provider Active NPI

Kimberlyn R Atherton Jenkins, DDS

  • General Practice Dentistry
  • Roswell, GA
National Provider Identifier
1164484390
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN015925 Issued in GA
Practice address
245 Boulder Dr
Roswell, GA 30075-4158
Phone
(540) 230-7835
NPI assigned
Apr 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN015925 GA Primary
Dentist 122300000X 0401410261 VA

Addresses

Primary practice location

245 Boulder Dr
Roswell, GA 30075-4158

Mailing address

245 Boulder Dr
Roswell, GA 30075-4158
Phone (540) 230-7835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0401410261VAMDDentist
DN015925GAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
New River Valley Dental, PLLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1164484390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 BOULDER DR",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300754158",
            "telephone_number": "540-230-7835",
            "fax_number": "540-951-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 BOULDER DR",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300754158",
            "telephone_number": "540-230-7835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATHERTON JENKINS",
        "first_name": "KIMBERLYN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015925",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401410261",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.