Basic Information
Provider Information
NPI: 1003806274
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JENKINS
FirstName: CHRISTOPHER
MiddleName: LACY
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 576 AZALEA RD
Address2: SUITE 105
City: MOBILE
State: AL
PostalCode: 366091516
CountryCode: US
TelephoneNumber: 2516655360
FaxNumber: 2516655361
Practice Location
Address1: 576 AZALEA RD
Address2: SUITE 105
City: MOBILE
State: AL
PostalCode: 366091516
CountryCode: US
TelephoneNumber: 2516655360
FaxNumber: 2516655361
Other Information
ProviderEnumerationDate: 10/27/2005
LastUpdateDate: 04/11/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X00021736ALY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

ID Information
IDTypeStateIssuerDescription
05155020405AL MEDICAID
BJ253127301 DEA NUMBEROTHER
AETNA01AL7957202OTHER
447998101ALCIGNAOTHER
5155020401ALBCBS ALOTHER


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