Healthcare Provider Details

I. General information

NPI: 1114247996
Provider Name (Legal Business Name): JOHN HEATH WEST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LIBERTY CREEK DR
SAVANNAH GA
31406-3224
US

IV. Provider business mailing address

20 LIBERTY CREEK DR
SAVANNAH GA
31406-3224
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-1174
  • Fax: 912-354-1174
Mailing address:
  • Phone: 912-354-1174
  • Fax: 912-354-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number11141
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: