Individual
SUSANNAH MARGARET JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
004832
GA
363AS0400X
Surgical Physician Assistant
Primary
004832
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004832
GA LICENSE
GA
05
—
0505PA
—
SC
Enumeration date
08/15/2006
Last updated
10/31/2013
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