Healthcare Provider Details

I. General information

NPI: 1164318408
Provider Name (Legal Business Name): VONEDTERA TOSHABA MACKLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11935 ABERCORN STREET
SAVANNAH GA
31419
US

IV. Provider business mailing address

11935 ABERCORN STREET
SAVANNAH GA
31419-1918
US

V. Phone/Fax

Practice location:
  • Phone: 912-657-9732
  • Fax:
Mailing address:
  • Phone: 912-657-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN314573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: