Individual
LONI ELISE JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3579 HIGHWAY 138 SE, SUITE 101, STOCKBRIDGE, GA 30281-4142
(770) 507-0029
(770) 507-9990
Mailing address
1065 JODECO RD, STOCKBRIDGE, GA 30281-4953
(678) 284-6300
(678) 284-6282
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
063358
GA
207Q00000X
Family Medicine Physician
141367
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141367
RESIDENT TRAINING LICENSE
NC
05
—
806901621A
—
GA
Enumeration date
06/12/2007
Last updated
03/17/2015
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