| Provider / Organization | NPI | Date Certified |
|---|---|---|
| EARNEST CALVIN BERNARD JENKINS | 1477141992 | 2021-01-10 |
| Entity Type | Individual |
| Provider Name | Mr. Earnest Calvin Bernard Jenkins Jr. MT013231 |
| Practice Office Address | 1335 ELDRICK LN GROVETOWN, GA US |
| Practice Office Telephone | 7066647882 |
| Mailing Address | 1335 ELDRICK LN GROVETOWN, GA 308138335 US |
| Business Telephone | 7066647882 |
| Code | License No | State |
|---|---|---|
| 225700000X PRIMARY | MT013231 | GA |