Healthcare Provider Details

I. General information

NPI: 1700830528
Provider Name (Legal Business Name): SAVANNAH THORACIC AND VASCULAR SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11702 MERCY BLVD PLAZA B SUITE 2-D
SAVANNAH GA
31419-1750
US

IV. Provider business mailing address

11702 MERCY BLVD PLAZA B SUITE 2-D
SAVANNAH GA
31419-1750
US

V. Phone/Fax

Practice location:
  • Phone: 912-961-9753
  • Fax: 912-961-9755
Mailing address:
  • Phone: 912-961-9753
  • Fax: 912-961-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY HUMPHRIES
Title or Position: MANAGER
Credential: MD
Phone: 912-961-9753