Healthcare Provider Details

I. General information

NPI: 1558394627
Provider Name (Legal Business Name): MARIA KRICHEVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MINIS AVE SUITE C-10
GARDEN CITY GA
31408-2128
US

IV. Provider business mailing address

219 WILEY BOTTOM RD
SAVANNAH GA
31411-1536
US

V. Phone/Fax

Practice location:
  • Phone: 912-966-5445
  • Fax: 912-966-5955
Mailing address:
  • Phone: 912-598-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number049048
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: