Healthcare Provider Details

I. General information

NPI: 1962584193
Provider Name (Legal Business Name): GATEWAY COMMUNITY SVC BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 70TH ST
SAVANNAH GA
31405-4813
US

IV. Provider business mailing address

800 E 70TH ST
SAVANNAH GA
31405-4813
US

V. Phone/Fax

Practice location:
  • Phone: 912-790-6220
  • Fax: 912-349-4328
Mailing address:
  • Phone: 912-790-6220
  • Fax: 912-349-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHRE006000
License Number StateGA

VIII. Authorized Official

Name: NANCY BRIGHT
Title or Position: PIC
Credential: RPH
Phone: 912-790-6220