Healthcare Provider Details

I. General information

NPI: 1508704347
Provider Name (Legal Business Name): SAVANNAH RIVER ADVANCED SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 MICHAELS CRK
EVANS GA
30809-4042
US

IV. Provider business mailing address

728 MICHAELS CRK
EVANS GA
30809-4042
US

V. Phone/Fax

Practice location:
  • Phone: 202-430-5326
  • Fax:
Mailing address:
  • Phone: 202-430-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAQUITO MARIO JORGE
Title or Position: CEO AND FOUNDER
Credential: MD
Phone: 312-523-1424