| Haven Medical Home PC | |
|
4480 Deer Run Evans GA 30809-4442 | |
| (706) 833-8810 | |
| (800) 504-1362 |
| Full Name | Haven Medical Home PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 4480 Deer Run, Evans, Georgia |
| Authorized Official Name and Position | Jennifer Ward (OWNER) |
| Authorized Official Contact | 7068338810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Haven Medical Home PC 4480 Deer Run Evans GA 30809-4442 Ph: (706) 833-8810 | Haven Medical Home PC 4480 Deer Run Evans GA 30809-4442 Ph: (706) 833-8810 |
| NPI Number | 1114587763 |
|---|---|
| Provider Enumeration Date | 06/17/2019 |
| Last Update Date | 08/05/2020 |
| Certification Date | 08/05/2020 |
| Medicare PECOS PAC ID | 2668897786 |
|---|---|
| Medicare Enrollment ID | O20210408001268 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114587763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Jennifer Ward |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891727749 PECOS PAC ID: 4486670080 Enrollment ID: I20051024000053 |
| Provider Name | Kristen H Benjamin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205022001 PECOS PAC ID: 3678626249 Enrollment ID: I20090729000425 |
| Provider Name | Sherrie L Wheeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508101312 PECOS PAC ID: 1850545112 Enrollment ID: I20140605002189 |
| Provider Name | Helena Ryan Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447729207 PECOS PAC ID: 6406194844 Enrollment ID: I20210408001376 |
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