Healthcare Provider Details

I. General information

NPI: 1861129587
Provider Name (Legal Business Name): PROCARE WELLNESS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EISENHOWER DR BLDG 500
SAVANNAH GA
31406-1600
US

IV. Provider business mailing address

340 EISENHOWER DR BLDG 500
SAVANNAH GA
31406-1600
US

V. Phone/Fax

Practice location:
  • Phone: 912-348-3818
  • Fax:
Mailing address:
  • Phone: 912-348-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DOMENICK PISCIOTTA
Title or Position: CLINIC OWNER
Credential:
Phone: 516-315-4732