Healthcare Provider Details

I. General information

NPI: 1407773682
Provider Name (Legal Business Name): KERI ROSE HAGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 EISENHOWER DR BLDG 1
SAVANNAH GA
31406-3928
US

IV. Provider business mailing address

1326 EISENHOWER DR BLDG 1
SAVANNAH GA
31406-3928
US

V. Phone/Fax

Practice location:
  • Phone: 912-527-5225
  • Fax: 912-527-5228
Mailing address:
  • Phone: 912-527-5225
  • Fax: 912-527-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP305163
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: