Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2005-06-01
- Last updated
- 2019-10-21
Licenses
- License GA
- 37976
- License GA
- 37976
- License SC
- 22152
- License GA
- 037976
Location
- Practice location
- 210 EAST DERENNE AVE
- City
- SAVANNAH GA
- Postal code
- 31405
- Phone
- 912-644-5300
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.