Healthcare Provider Details

I. General information

NPI: 1992707145
Provider Name (Legal Business Name): JOHN M. CONSIDINE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 EAST DERENNE AVE
SAVANNAH GA
31405
US

IV. Provider business mailing address

210 EAST DERENNE AVE
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-644-5300
  • Fax: 912-644-5241
Mailing address:
  • Phone: 912-644-5300
  • Fax: 912-644-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number37976
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number37976
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22152
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number037976
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: