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General NPI Number Information
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NPI Number | 1871196519
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Entity Type | Organization
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Legal Business Name | RENUVEN HEALTH PARTNERS OF GEORGIA PC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2403 BATTLEFIELD PKWY
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4033
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Country | US
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Telephone | 423-979-5804
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 E OAKLAND AVE
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City | JOHNSON CITY
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State | TN
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Zip | 37601-1843
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Country | US
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Telephone | 423-926-2358
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BERT J. SMITH
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Credential | MD
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Telephone | 423-926-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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