Provider Demographics
NPI:1316988975
Name:JENKINS, MARION KENT (MD)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:KENT
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654-1503
Mailing Address - Country:US
Mailing Address - Phone:864-369-0552
Mailing Address - Fax:864-369-1826
Practice Address - Street 1:21 S SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654-1503
Practice Address - Country:US
Practice Address - Phone:864-369-0552
Practice Address - Fax:864-369-1826
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC210621Medicaid
S476721OtherMEDCOST
H07117Medicare UPIN
SC6608Medicare PIN