Healthcare Provider Details

I. General information

NPI: 1912167578
Provider Name (Legal Business Name): CHRYSELLE NAZARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CHATHAM CTR S STE C
SAVANNAH GA
31405-7455
US

IV. Provider business mailing address

PO BOX 15849
SAVANNAH GA
31416-2549
US

V. Phone/Fax

Practice location:
  • Phone: 912-527-7211
  • Fax: 912-527-7222
Mailing address:
  • Phone: 912-303-3552
  • Fax: 912-303-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number066389
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number066389
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: