Provider Demographics
NPI:1548298383
Name:JENKINS, HULANNIE (MD)
Entity type:Individual
Prefix:
First Name:HULANNIE
Middle Name:
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 1:880 MARIETTA HWY STE 630
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6776
Mailing Address - Country:US
Mailing Address - Phone:540-230-1903
Mailing Address - Fax:
Practice Address - Street 1:245 BOULDER DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4158
Practice Address - Country:US
Practice Address - Phone:540-230-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83285207P00000X
VA0101225499207P00000X
FLME39797207P00000X
MI4301062798207P00000X
OH35045101207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02010Medicare UPIN