Healthcare Provider Details

I. General information

NPI: 1063663615
Provider Name (Legal Business Name): WILFREDO ALEXIS NEGRON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 304
SAVANNAH GA
31405-6010
US

IV. Provider business mailing address

5354 REYNOLDS ST STE 304
SAVANNAH GA
31405-6010
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-7303
  • Fax:
Mailing address:
  • Phone: 912-355-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME144816
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number70292
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: