Individual
JESSE LANE JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1734 COLD SPRINGS RD, MOUNTAIN CITY, TN 37683-4040
(423) 440-9174
Mailing address
1734 COLD SPRINGS RD, MOUNTAIN CITY, TN 37683-4040
(423) 440-9174
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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