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NPI Code Detail

MEDICARE: DR. JENNIFER PORTER HERBERT M.D.

MEDICARE: DR. JENNIFER PORTER HERBERT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician60380GA

General Provider Information

NPI Number : 1417077355
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER PORTER HERBERT M.D.
Provider Business Mailing Address
First Line : PO BOX 1705
Second Line :
City : AUGUSTA
State : GA
Zip : 30903-1705
Country : US
Telephone Number : 706-774-7263
Fax Number : 706-774-7230
Provider Business Practice Location Address
First Line : 1043 WASHINGTON RD
Second Line :
City : THOMSON
State : GA
Zip : 30824-7318
Country : US
Telephone Number : 706-595-1461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2007
Last Update Date : 05/01/2026

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