1710188990 NPI number — DR. EMILY O JENKINS M.D.

Table of content: DR. EMILY O JENKINS M.D. (NPI 1710188990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710188990 NPI number — DR. EMILY O JENKINS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
EMILY
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLDHAM
Provider Other First Name:
EMILY
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710188990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 THOMSON DR
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24501-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-200-5925
Provider Business Mailing Address Fax Number:
434-200-5929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 THOMSON DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24501-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-200-5925
Provider Business Practice Location Address Fax Number:
434-200-5929
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  0101253917 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 2010-01672 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 207RH0003X . This is a "VIRGINIA STATE MEDICAL LICENSE NUMBER TAXONOMY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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