Healthcare Provider Details

I. General information

NPI: 1386740249
Provider Name (Legal Business Name): SURESH I PERSAD-MAHARAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 B COMMERCIAL DR.
SAVANNAH GA
31406-3643
US

IV. Provider business mailing address

361 B COMMERCIAL DR.
SAVANNAH GA
31406-3643
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-7936
  • Fax: 912-352-0079
Mailing address:
  • Phone: 912-352-7936
  • Fax: 912-352-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberGA17717
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17717
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: