DR. JACK OSBORNE JENKINS (NPI# 1639369515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639369515 |
| Entity Type | Individual |
| Full Name | DR. JACK OSBORNE JENKINS |
| Credential | PH.D. |
| Practice Address |
415 Dixie St Carrollton GA 30117-3921 |
| Mailing Address |
303 Old Camp Church Rd Carrollton GA 30117-8207 |
| Practice Telephone | 6782302046 |
| Mailing Telephone | 6782302046 |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2007-07-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
PSY000651 | GA | Behavioral Health & Social Service Providers |
| Street Address |
415 DIXIE ST |
| City | CARROLLTON |
| State | GA |
| Zip Code | 30117-3921 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487690343 | Theresa Marie Masek | Counselor | 415 Dixie St, Carrollton, GA 30117-3921 | 2006-06-21 |
| 1902287949 | Life Journeys, Lln | Counselor | 415 Dixie St, Carrollton, GA 30117-3921 | 2015-06-16 |
| 1427374024 | Bodymind Therapeutics, Inc. | Counselor | 415 Dixie St, Carrollton, GA 30117-3921 | 2010-04-08 |
| 1780817387 | Theodore H Ceccoli | Counselor | 415 Dixie St, Carrollton, GA 30117-3921 | 2009-08-29 |
| 1972791853 | Theresa Masek,lpc | Community/Behavioral Health | 415 Dixie St, Carrollton, GA 30117-3921 | 2007-10-04 |
| 1609082882 | Patricia Harman | Counselor | 415 Dixie St, Carrollton, GA 30117-3921 | 2007-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679199392 | Southern Rad Onc LLC | Radiology | 809 South Park Street, Carrollton, GA 30117 | 2020-06-18 |
| 1093361404 | Eyedeal Eyecare LLC | Optometrist | 1735 S Us 27, Carrollton, GA 30117 | 2019-08-12 |
| 1710412473 | Janis James | Optometrist | 1735 S, Us-27, Walmart Vision Center, Carrollton, GA 30117 | 2017-05-01 |
| 1568881951 | Omar Hajmurad | Anesthesiology | 812 S Park St Ste 5, Carrollton, GA 30117 | 2014-04-14 |
| 1134550353 | Goodbodys Minor Med Express Care | Nurse Practitioner | 1670 South Park St., Carrollton, GA 30117 | 2013-12-13 |
| 1306187570 | Myriam C Vela-ortiz | Internal Medicine | 157 Clinic Ave Ste 203, Carrollton, GA 30117 | 2013-03-12 |
| 1891030201 | Air Evac Ems, Inc. | Ambulance | 827 Old Bremen Rd, Carrollton, GA 30117 | 2012-12-11 |
| 1952682486 | Angelic Wings Transport, Inc. | Non-emergency Medical Transport (VAN) | 362 B Columbia Drive, Carrollton, GA 30117 | 2011-08-29 |
| 1073819256 | Atlanta Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 812 South Park Street, Suite 2, Carrollton, GA 30117 | 2011-02-04 |
| 1255640348 | Amy Gilbert | Counselor | 515 Tanner St, Carrollton, GA 30117 | 2010-10-06 |
| Find all providers in zip 30117 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124332911 | Teach Me LLC | Psychologist | 2020 E Hebron Pkwy, Suite 110, Carrollton, TX 75007-1618 | 2010-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215403340 | Camino Psychological Services, LLC | Psychologist | 2450 Atlanta Hwy Ste 1903, Cumming, GA 30040-1237 | 2018-10-16 |
| 1790299386 | Marcus Dawson | Psychologist | 498 Hudgeons Rd, Warrenton, GA 30828-5444 | 2017-11-19 |
| 1992245732 | Cynthia Anita Hucks-smith | Psychologist | 5012 Paulsen St., Bldg 7, Savannah, GA 31405-4624 | 2017-02-27 |
| 1720483340 | Jessica Haley Geddes | Psychologist | 595 Wimbledon Rd Ne, Atlanta, GA 30324-4965 | 2014-10-24 |
| 1366847097 | Lydia Odenat | Psychologist | 1640 Powers Ferry Rd Se Bldg 18-250, Marietta, GA 30067-9461 | 2014-10-23 |
| 1801145354 | Richard M Anderson | Psychologist | 21 Windsor On The Marsh, Savannah, GA 31419-2409 | 2012-08-30 |
| 1023341518 | Christine R Petro, Psy.d., LLC | Psychologist | 69 Grayson New Hope Rd, Grayson, GA 30017 | 2009-09-15 |
| 1982879425 | Sara Michelle Velez | Psychologist | 645 Hembree Pkwy Ste A, Roswell, GA 30076-3868 | 2008-04-25 |
| 1033394820 | Mark Gilson Phd PC | Psychologist | 1772 Century Boulevard, Ne, Atlanta, GA 30345-3396 | 2007-12-31 |
| 1316159569 | Paul Lavere Fair | Psychologist | 3580 Piedmont Road, Suite 220, Atlanta, GA 30305-1506 | 2007-05-03 |
| Find all providers with the same taxonomy | ||||
| City | CARROLLTON |
| Zip Code | 30117 |
Please comment or provide details below to improve the information on DR. JACK OSBORNE JENKINS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.