Haven Medical Home PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HAVEN MEDICAL HOME PC

Practice address

4480 Deer Run
Evans, GA 30809-4442

Phone

(706) 833-8810

Fax

(800) 504-1362

NPI assigned

Jun 17, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Ward, DONPI 1891727749

Title

Owner

Phone

(706) 833-8810

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Ward, D.O.

  • Internal Medicine Physician
  • Evans, GA
  • NPI 1891727749

  GA

  Medicare reassignment Authorized official
• Kristen Heather Benjamin, APRN, BC

  • Family Nurse Practitioner
  • Augusta, GA
  • NPI 1205022001

  GA

  Medicare reassignment NPD
• Sherrie Lynn Wheeler

  • Nurse Practitioner
  • Augusta, GA
  • NPI 1508101312

  GA

  Medicare reassignment NPD
• Helena Ryan Garner, APRN

  • Nurse Practitioner
  • Columbia, SC
  • NPI 1447729207

  GA

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596585600000",
    "number": "1114587763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 DEER RUN",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094442",
            "telephone_number": "706-833-8810",
            "fax_number": "800-504-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 DEER RUN",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094442",
            "telephone_number": "706-833-8810",
            "fax_number": "800-504-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVEN MEDICAL HOME PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-833-8810",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Harris
• Lisa McCord Harrison
• James David Harrover III, M.D.
• Patricia Hartlage, M.D.
• Kristi Hasten, O.T.
• Hawk Therapy Services LLC
• India Shae Hawk, OT
• Thomas Hawk, PT
• Amanda Stroud Hayes
• Patricia Michelle Haynes

• All providers in Evans, GA
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.