Provider Demographics
NPI:1114587763
Name:HAVEN MEDICAL HOME PC
Entity Type:Organization
Organization Name:HAVEN MEDICAL HOME PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-833-8810
Mailing Address - Street 1:4480 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4442
Mailing Address - Country:US
Mailing Address - Phone:706-833-8810
Mailing Address - Fax:800-504-1362
Practice Address - Street 1:4480 DEER RUN
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4442
Practice Address - Country:US
Practice Address - Phone:706-833-8810
Practice Address - Fax:800-504-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty