Healthcare Provider Details

I. General information

NPI: 1346496312
Provider Name (Legal Business Name): EAR, NOSE & THROAT ASSOCIATES OF SAVANNAH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N RIVER ST
CLAXTON GA
30417-1659
US

IV. Provider business mailing address

5201 FREDERICK ST
SAVANNAH GA
31405-4501
US

V. Phone/Fax

Practice location:
  • Phone: 912-739-5246
  • Fax: 912-739-2117
Mailing address:
  • Phone: 912-351-3030
  • Fax: 912-351-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JAN BOWERS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 912-629-4502