Healthcare Provider Details

I. General information

NPI: 1154369270
Provider Name (Legal Business Name): RUDOLF JAKOB HEHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GORDON AVE
THOMASVILLE GA
31792-6614
US

IV. Provider business mailing address

PO BOX 708848
SANDY UT
84070-8848
US

V. Phone/Fax

Practice location:
  • Phone: 229-228-2000
  • Fax:
Mailing address:
  • Phone: 866-869-2395
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number026302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: