Active NPI
Latrina Jenkins
- Prosthetic/Orthotic Supplier
- Augusta, GA
National Provider Identifier
1902495880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- LCB20190001116
- Practice address
- 116 Shartom Dr
Augusta, GA 30907-4748 - Phone
- (706) 294-9434
- Fax
- (651) 800-9979
- NPI assigned
- Jan 14, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | LCB20190001116 | GA | Primary |
Addresses
Primary practice location
116 Shartom Dr
Augusta, GA 30907-4748
Mailing address
116 Shartom Dr
Augusta, GA 30907-4748
Phone (706) 294-9434
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 |
|---|---|---|---|
| LCB20190001116 | GA | MD | Prosthetic/Orthotic Supplier |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1902495880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 SHARTOM DR",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309074748",
"telephone_number": "706-294-9434",
"fax_number": "651-800-9979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 SHARTOM DR",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309074748",
"telephone_number": "706-294-9434",
"fax_number": "651-800-9979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "LATRINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-14",
"last_updated": "2021-01-14",
"certification_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "GA",
"license": "LCB20190001116",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.