Healthcare Provider Details

I. General information

NPI: 1750125142
Provider Name (Legal Business Name): SAVANNAH CHISOM AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 USA DRIVE NORTH HAHN 1119
MOBILE AL
36688-0002
US

IV. Provider business mailing address

PO BOX 746450
ATLANTA GA
30374-6450
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-9378
  • Fax: 251-445-9377
Mailing address:
  • Phone: 866-401-3057
  • Fax: 318-868-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1401A
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7973
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: