Healthcare Provider Details

I. General information

NPI: 1295737328
Provider Name (Legal Business Name): MELVIN LEE HAYSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 WATERS AVE
SAVANNAH GA
31404-6234
US

IV. Provider business mailing address

5400 WATERS AVE
SAVANNAH GA
31404-6234
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-5410
  • Fax: 912-354-0466
Mailing address:
  • Phone: 912-355-5410
  • Fax: 912-354-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number14507
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: