Healthcare Provider Details

I. General information

NPI: 1760985311
Provider Name (Legal Business Name): E.V INFUSIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SOUTHERN JUNCTION BLVD STE 201
POOLER GA
31322-2214
US

IV. Provider business mailing address

203 MALLARD LOOP RD
SAVANNAH GA
31405-8123
US

V. Phone/Fax

Practice location:
  • Phone: 912-450-1160
  • Fax: 912-450-3971
Mailing address:
  • Phone: 912-450-1160
  • Fax: 912-450-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN140169
License Number StateGA

VIII. Authorized Official

Name: SHALI M. REYNOLDS
Title or Position: PRESIDENT/CEO
Credential: ANP-BC
Phone: 912-656-6122