Healthcare Provider Details

I. General information

NPI: 1770522930
Provider Name (Legal Business Name): MELISSA DECKER CRENSHAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 WATERS AVE STE 311
SAVANNAH GA
31404
US

IV. Provider business mailing address

4750 WATERS AVE STE 311
SAVANNAH GA
31404-6268
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-5937
  • Fax: 912-350-7514
Mailing address:
  • Phone: 912-350-5937
  • Fax: 912-350-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number053440
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: