Healthcare Provider Details

I. General information

NPI: 1790487452
Provider Name (Legal Business Name): MERYSSAH LORRAINE TENEWITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

4700 WATERS AVE
SAVANNAH GA
31404-6220
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-8193
  • Fax:
Mailing address:
  • Phone: 912-350-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number114031
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: