Provider Demographics
NPI:1891538641
Name:HAWORTH, JEFFREY M (NRP)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:HAWORTH
Suffix:
Gender:M
Credentials:NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13522
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-3522
Mailing Address - Country:US
Mailing Address - Phone:478-342-5480
Mailing Address - Fax:404-738-1650
Practice Address - Street 1:2124 RIVERSIDE DR STE 175
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1747
Practice Address - Country:US
Practice Address - Phone:478-342-5480
Practice Address - Fax:404-738-1650
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAP032513146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic