Healthcare Provider Details

I. General information

NPI: 1205509858
Provider Name (Legal Business Name): SAVANNAH ENDOCRINOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SOUTHERN BLVD # 103
SAVANNAH GA
31405-7437
US

IV. Provider business mailing address

107 SOUTHERN BLVD # 103
SAVANNAH GA
31405-7437
US

V. Phone/Fax

Practice location:
  • Phone: 912-232-5900
  • Fax: 912-244-6744
Mailing address:
  • Phone: 912-232-5900
  • Fax: 912-244-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ISMARY OJEDA DE CASTRO
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 912-344-5037