Healthcare Provider Details

I. General information

NPI: 1114007630
Provider Name (Legal Business Name): JENNIFER MILLER RAFUS M.S., FNP, LIC. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MILLER PERRY M.S.FNP

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615A PENDLETON ST
WAYCROSS GA
31501-4724
US

IV. Provider business mailing address

615A PENDLETON ST
WAYCROSS GA
31501-4724
US

V. Phone/Fax

Practice location:
  • Phone: 912-548-0710
  • Fax:
Mailing address:
  • Phone: 912-548-0710
  • Fax: 912-548-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN235259
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN235259
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: