Healthcare Provider Details

I. General information

NPI: 1306977624
Provider Name (Legal Business Name): CAROLINE EH ZUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 66TH ST
SAVANNAH GA
31404-5704
US

IV. Provider business mailing address

1206 E 66TH ST
SAVANNAH GA
31404-5704
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-4601
  • Fax:
Mailing address:
  • Phone: 912-355-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003660
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: