MEDICARE: JENNIFER PAIGE FORSHAY-RODEFER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0001922	GA

General Provider Information

NPI Number	:	1356001499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PAIGE FORSHAY-RODEFER

Provider Business Mailing Address
First Line	:	1266 WAVERLAND DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1322
Country	:	US
Telephone Number	:	850-294-0047
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 INGLESIDE AVE
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2028
Country	:	US
Telephone Number	:	478-227-0993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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