Healthcare Provider Details

I. General information

NPI: 1881066504
Provider Name (Legal Business Name): SURESH PERSAD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 COMMERCIAL DR SUITE B
SAVANNAH GA
31406-3659
US

IV. Provider business mailing address

361 COMMERCIAL DR SUITE B
SAVANNAH GA
31406-3659
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 TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number17717
License Number StateGA

VIII. Authorized Official

Name: MS. MARY N NWOSU
Title or Position: PRACTICE MANAGER
Credential:
Phone: 912-352-7936