Healthcare Provider Details

I. General information

NPI: 1205086931
Provider Name (Legal Business Name): TIMOTHY JOHN MINTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5356 REYNOLDS STREET SUITE 505
SAVANNAH GA
31405
US

IV. Provider business mailing address

836 E. 65TH STREET SUITE 22
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-644-0744
  • Fax: 912-644-0756
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number251241
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number072876
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: