Healthcare Provider Details

I. General information

NPI: 1487383675
Provider Name (Legal Business Name): RYAN C SU FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EISENHOWER DR STE 1200
SAVANNAH GA
31406-2675
US

IV. Provider business mailing address

428 HUNT DR
SAVANNAH GA
31406-8956
US

V. Phone/Fax

Practice location:
  • Phone: 912-443-4200
  • Fax:
Mailing address:
  • Phone: 912-658-8330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN287142
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: