Healthcare Provider Details

I. General information

NPI: 1770205379
Provider Name (Legal Business Name): REJUVENATE HEALTH MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 PERSIMMONS ST STE 105
BLUFFTON SC
29910-7656
US

IV. Provider business mailing address

53 PERSIMMONS ST
BLUFFTON SC
29910-7655
US

V. Phone/Fax

Practice location:
  • Phone: 843-757-7836
  • Fax: 843-757-7837
Mailing address:
  • Phone: 843-757-7836
  • Fax: 843-757-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNY NEWCOMB
Title or Position: CONTACT
Credential:
Phone: 631-736-4064