Provider Demographics
NPI:1164280384
Name:REJUVENANT FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:REJUVENANT FAMILY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-309-5500
Mailing Address - Street 1:2140 RIVERSIDE DR STE C
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1792
Mailing Address - Country:US
Mailing Address - Phone:478-309-5500
Mailing Address - Fax:478-309-5510
Practice Address - Street 1:2140 RIVERSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1792
Practice Address - Country:US
Practice Address - Phone:478-309-5500
Practice Address - Fax:478-309-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty