Healthcare Provider Details

I. General information

NPI: 1902882160
Provider Name (Legal Business Name): SAVANNAH PLASTIC SURGICENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 HODGSON MEMORIAL DRIVE
SAVANNAH GA
31406-2512
US

IV. Provider business mailing address

7208 HODGSON MEMORIAL DRIVE
SAVANNAH GA
31406-2512
US

V. Phone/Fax

Practice location:
  • Phone: 912-351-5050
  • Fax: 912-351-5051
Mailing address:
  • Phone: 912-351-5050
  • Fax: 912-351-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MARY F MCLEAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 912-351-5050