Provider Demographics
NPI:1861593089
Name:JENKINS, MARK GUERRY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GUERRY
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-273-1100
Mailing Address - Fax:912-273-1111
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-355-0070
Practice Address - Fax:912-355-3220
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031770207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00394963AMedicaid
GAC84716Medicare UPIN
GA00394963AMedicaid