Healthcare Provider Details

I. General information

NPI: 1174508576
Provider Name (Legal Business Name): ANA MARIA CONCEPCION-CASTRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11702 MERCY BLVD STE. 2E
SAVANNAH GA
31419-1750
US

IV. Provider business mailing address

11702 MERCY BLVD STE. 2E
SAVANNAH GA
31419-1750
US

V. Phone/Fax

Practice location:
  • Phone: 912-925-8883
  • Fax: 912-925-8689
Mailing address:
  • Phone: 912-925-8883
  • Fax: 912-925-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number047070
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number047070
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: