Healthcare Provider Details

I. General information

NPI: 1578486205
Provider Name (Legal Business Name): SAVANA JAYDE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19690 GREENO RD
FAIRHOPE AL
36532-3840
US

IV. Provider business mailing address

19690 GREENO RD
FAIRHOPE AL
36532-3840
US

V. Phone/Fax

Practice location:
  • Phone: 601-347-6332
  • Fax:
Mailing address:
  • Phone: 601-347-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-209974
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: