Provider Demographics
NPI:1154435790
Name:JENKINS, JAMES A JR (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EAST HOSPITAL ROAD
Mailing Address - Street 2:DDEAMC
Mailing Address - City:FORT GODON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-6624
Mailing Address - Fax:706-787-8180
Practice Address - Street 1:BUILDING 40701, 41ST ST
Practice Address - Street 2:DDEAMC
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-6624
Practice Address - Fax:706-787-8180
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW003109104100000X
GACSW0040191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYVAD000Medicare UPIN