| John Marshall Jenkins Phd Llc | |
|
504 Riverside Pkwy Ne Ste 110 Rome GA 30161-2981 | |
| (706) 766-1937 | |
| Not Available |
| Full Name | John Marshall Jenkins Phd Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 504 Riverside Pkwy Ne Ste 110, Rome, Georgia |
| Authorized Official Name and Position | John Marshall Jenkins (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 7067661937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Marshall Jenkins Phd Llc Po Box 441 Rome GA 30162-0441 Ph: (706) 766-1937 | John Marshall Jenkins Phd Llc 504 Riverside Pkwy Ne Ste 110 Rome GA 30161-2981 Ph: (706) 766-1937 |
| NPI Number | 1720672645 |
|---|---|
| Provider Enumeration Date | 02/22/2021 |
| Last Update Date | 12/22/2021 |
| Certification Date | 12/22/2021 |
| Medicare PECOS PAC ID | 2163838517 |
|---|---|
| Medicare Enrollment ID | O20210309002103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720672645 | NPI | - | NPPES |
| 1861443921 | Other | NPPES INDIVIDUAL NPI | |
| PSY001194 | Other | GA | GEORGIA PSYCHOLOGIST LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | John M Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861443921 PECOS PAC ID: 2264442011 Enrollment ID: I20060425000333 |
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