Healthcare Provider Details

I. General information

NPI: 1063583458
Provider Name (Legal Business Name): JEFFREY M MCEVER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 REDMOND RD NW
ROME GA
30165-1416
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 762-235-2200
  • Fax: 706-236-6434
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: