Individual
BOLIVIA TRACI JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1005 BOULDER DR, GRAY, GA 31032-6141
(478) 621-2072
Mailing address
1005 BOULDER DR, GRAY, GA 31032-6141
(478) 621-2072
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
99763
GA
Other
Enumeration date
03/30/2021
Last updated
08/15/2024
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