Individual
MARK JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 W MAIN BLVD, CHURCH HILL, TN 37642-3915
(423) 282-1480
(423) 928-1353
Mailing address
PO BOX 4018, JOHNSON CITY, TN 37602-4018
(423) 282-1480
(423) 928-1353
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21019
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558364810
—
VA
05
—
3052551
—
TN
05
—
5610222
—
VA
01
—
P01081201
RAILROAD MEDICARE
TN
Enumeration date
05/31/2005
Last updated
03/17/2018
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