Individual
ANGELA D JENKINS I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
380 HOSPITAL DR., STE 410, MACON, GA 31217-8014
(478) 746-5644
(478) 745-4849
Mailing address
380 HOSPITAL DR., STE 410, MACON, GA 31217-8014
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN144846
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269333706A
—
GA
01
—
549669
WELLCARE
GA
01
—
580628385
TRICARE
GA
05
—
AN1383
—
SC
01
—
P00819049
RAILROAD MEDICARE
GA
Enumeration date
01/18/2006
Last updated
12/13/2010
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