Healthcare Provider Details

I. General information

NPI: 1871057828
Provider Name (Legal Business Name): MICHAEL PEYTON FANNING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E 36TH ST
SAVANNAH GA
31401-8604
US

IV. Provider business mailing address

206 E 36TH ST
SAVANNAH GA
31401-8604
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-1501
  • Fax: 912-232-9138
Mailing address:
  • Phone: 912-819-1501
  • Fax: 912-232-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number114398
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101270352
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101270352
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: