Healthcare Provider Details

I. General information

NPI: 1629251699
Provider Name (Legal Business Name): SAVANNAH ENDOCRINE & DIABETES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EISENHOWER DR #1600
SAVANNAH GA
31406-1600
US

IV. Provider business mailing address

340 EISENHOWER DR #1600
SAVANNAH GA
31406-1600
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-6029
  • Fax: 912-352-3071
Mailing address:
  • Phone: 912-355-6029
  • Fax: 912-352-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number026286
License Number StateGA

VIII. Authorized Official

Name: MRS. ELISE GERBSCH GRESHAM
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 912-355-6029