Healthcare Provider Details

I. General information

NPI: 1639682420
Provider Name (Legal Business Name): SAVANNAH PEDIATRIC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 PAULSEN ST BLDG 3
SAVANNAH GA
31405-4614
US

IV. Provider business mailing address

2000 HEALTH PARK DR
BRENTWOOD TN
37027-4525
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-7914
  • Fax:
Mailing address:
  • Phone: 615-372-5426
  • Fax: 866-831-4898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A FAILE
Title or Position: VICE PRESIDENT
Credential:
Phone: 843-856-7923