Healthcare Provider Details

I. General information

NPI: 1023002730
Provider Name (Legal Business Name): DOLORES J HAVILAND-FOLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ST. JOSEPH'S CANDLER DRIVE SUITE 200
POOLER GA
31322
US

IV. Provider business mailing address

836 E. 65TH STREET SUITE 20
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-1999
  • Fax: 912-748-3847
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number046860
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46860
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: