Provider Demographics
NPI:1427250299
Name:HARVETTE C JENKINS
Entity type:Organization
Organization Name:HARVETTE C JENKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVETTE
Authorized Official - Middle Name:CARMELLE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-274-5000
Mailing Address - Street 1:4510 PREMIER DR
Mailing Address - Street 2:STE. 101 A
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8349
Mailing Address - Country:US
Mailing Address - Phone:336-274-5000
Mailing Address - Fax:336-274-5064
Practice Address - Street 1:4510 PREMIER DR
Practice Address - Street 2:STE. 101 A
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8349
Practice Address - Country:US
Practice Address - Phone:336-274-5000
Practice Address - Fax:336-274-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC129NWOtherBCBS
NC89129NWMedicaid
NC89129NWMedicaid