Healthcare Provider Details

I. General information

NPI: 1811361108
Provider Name (Legal Business Name): YORK NEUROLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BARNARD ST SUITE 300
SAVANNAH GA
31401-2500
US

IV. Provider business mailing address

35 BARNARD ST SUITE 300
SAVANNAH GA
31401-2500
US

V. Phone/Fax

Practice location:
  • Phone: 912-235-6790
  • Fax: 912-235-6791
Mailing address:
  • Phone: 912-235-6790
  • Fax: 912-235-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number69851
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number56094
License Number StateGA

VIII. Authorized Official

Name: TAMMY CARPENTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-235-6790