Healthcare Provider Details

I. General information

NPI: 1265678932
Provider Name (Legal Business Name): SUSAN BRYANT PURVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MULBERRY BLVD STE 100
SAVANNAH GA
31407-3507
US

IV. Provider business mailing address

101 W MULBERRY BLVD STE 100
SAVANNAH GA
31407-3507
US

V. Phone/Fax

Practice location:
  • Phone: 912-350-5937
  • Fax: 912-273-1033
Mailing address:
  • Phone: 912-350-5937
  • Fax: 912-273-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN2209982
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN2209982
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN330666
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: