Healthcare Provider Details

I. General information

NPI: 1952454167
Provider Name (Legal Business Name): SAVANNAH PELVIC RECONSTRUCTIVE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5356 REYNOLDS ST STE 301
SAVANNAH GA
31405-6016
US

IV. Provider business mailing address

PO BOX 23028
SAVANNAH GA
31403-3028
US

V. Phone/Fax

Practice location:
  • Phone: 912-303-0891
  • Fax: 912-303-0893
Mailing address:
  • Phone: 912-303-0891
  • Fax: 912-303-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number041008
License Number StateGA

VIII. Authorized Official

Name: MRS. RITA NICO MURPHY
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-232-9700