Healthcare Provider Details

I. General information

NPI: 1841415874
Provider Name (Legal Business Name): CHATHAM ORAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/08/2022
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EISENHOWER DR
SAVANNAH GA
31406-2668
US

IV. Provider business mailing address

501 EISENHOWER DR
SAVANNAH GA
31406-2668
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-1515
  • Fax: 912-354-8181
Mailing address:
  • Phone: 912-354-1515
  • Fax: 912-354-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number011165
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL C WILSON
Title or Position: PARTNER
Credential: DMD
Phone: 912-354-1515