Healthcare Provider Details

I. General information

NPI: 1508001496
Provider Name (Legal Business Name): CLAUDEL GRATIA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MALL BLVD STE 202E
SAVANNAH GA
31406-4834
US

IV. Provider business mailing address

401 MALL BLVD STE 202E
SAVANNAH GA
31406-4834
US

V. Phone/Fax

Practice location:
  • Phone: 912-600-1176
  • Fax: 912-600-1298
Mailing address:
  • Phone: 912-600-1176
  • Fax: 912-600-1298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37363
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number078900
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: