Healthcare Provider Details

I. General information

NPI: 1982769568
Provider Name (Legal Business Name): SAVANNAH MEDICAL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 505
SAVANNAH GA
31405-6012
US

IV. Provider business mailing address

5354 REYNOLDS ST STE 505
SAVANNAH GA
31405-6012
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-1553
  • Fax: 912-355-3528
Mailing address:
  • Phone: 912-352-1553
  • Fax: 912-355-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number017705
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number031689
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3752
License Number StateGA

VIII. Authorized Official

Name: DR. MOHAMMAD ALI MASROOR
Title or Position: PRESIDENT
Credential: MD
Phone: 912-352-1553