Healthcare Provider Details

I. General information

NPI: 1689554545
Provider Name (Legal Business Name): JAMEL MAURICE PORTER EPC; ACSM EP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 W 42ND ST
SAVANNAH GA
31415-8950
US

IV. Provider business mailing address

658 W 42ND ST
SAVANNAH GA
31415-8950
US

V. Phone/Fax

Practice location:
  • Phone: 912-328-9001
  • Fax:
Mailing address:
  • Phone: 912-328-9001
  • Fax: 912-428-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberF7X9G3G5
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number475
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: