Healthcare Provider Details

I. General information

NPI: 1437633328
Provider Name (Legal Business Name): ZACHARY EMANUEL MADRAMOOTOO N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 REYNOLDS ST
SAVANNAH GA
31405-6015
US

IV. Provider business mailing address

5629 HWY 21 S
RINCON GA
31326-9416
US

V. Phone/Fax

Practice location:
  • Phone: 912-295-2133
  • Fax:
Mailing address:
  • Phone: 912-295-2133
  • Fax: 912-295-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN222405
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: