Healthcare Provider Details

I. General information

NPI: 1447385539
Provider Name (Legal Business Name): DEYANIRA JEREZ PRASTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 MERCY BLVD BLDG 1
SAVANNAH GA
31419-1753
US

IV. Provider business mailing address

836 E 65TH ST STE 22
SAVANNAH GA
31405-4493
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-0500
  • Fax: 912-819-0501
Mailing address:
  • Phone: 912-819-2622
  • Fax: 912-819-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: