Healthcare Provider Details

I. General information

NPI: 1063473197
Provider Name (Legal Business Name): SAVANNAH RADIOLOGISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOHNSTON STREET SUITE 12
SAVANNAH GA
31405-5531
US

IV. Provider business mailing address

1 JOHNSTON STREET SUITE 12
SAVANNAH GA
31405-5531
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-7089
  • Fax: 912-692-8957
Mailing address:
  • Phone: 912-354-7089
  • Fax: 912-692-8957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number034456
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: JOYCE T BROUGHAN
Title or Position: MANAGER
Credential:
Phone: 912-354-7089