Healthcare Provider Details

I. General information

NPI: 1114987757
Provider Name (Legal Business Name): ANDREW L. PENDLETON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

4750 WATERS AVE STE 103
SAVANNAH GA
31404-6267
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-8180
  • Fax: 912-350-5697
Mailing address:
  • Phone: 912-350-5646
  • Fax: 912-350-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number067429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: