Basic Information
| Provider Information | |||||||||
| NPI: | 1245444009 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTOPHER L. JENKINS, M.D., L.L.C. | ||||||||
| LastName: | |||||||||
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| 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: | 05/10/2007 | ||||||||
| LastUpdateDate: | 06/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | JENKINS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | LACY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2516505360 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 21736 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 051550204 | 05 | AL | MEDICAID |