Active NPI
Neddie Nicole Jenkins
- Speech-Language Pathologist
- Fitzgerald, GA
National Provider Identifier
1245394824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 004805
- Practice address
- 162 Abba Rd
Fitzgerald, GA 31750-6047 - Phone
- (706) 294-3773
- Fax
- (803) 202-0334
- NPI assigned
- Dec 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 004805 | GA | Primary |
Addresses
Primary practice location
162 Abba Rd
Fitzgerald, GA 31750-6047
Mailing address
996 Shadwell Dr
Evans, GA 30809-4539
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
| License | State | Type | Specialty |
|---|---|---|---|
| 004805 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1245394824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "996 SHADWELL DR",
"city": "EVANS",
"state": "GA",
"postal_code": "308094539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "162 ABBA RD",
"city": "FITZGERALD",
"state": "GA",
"postal_code": "317506047",
"telephone_number": "706-294-3773",
"fax_number": "803-202-0334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "NEDDIE",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-20",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "004805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fitzgerald, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.