Healthcare Provider Details

I. General information

NPI: 1336176981
Provider Name (Legal Business Name): SUSAN G. MAZO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE
SAVANNAH GA
31404
US

IV. Provider business mailing address

4700 WATERS AVE
SAVANNAH GA
31404-6220
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-8016
  • Fax: 912-350-7221
Mailing address:
  • Phone: 912-350-8180
  • Fax: 912-350-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number028044
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number028044
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: