Healthcare Provider Details

I. General information

NPI: 1316821069
Provider Name (Legal Business Name): SAVANNAH JANE CORBITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 DESTINY LN STE 110
BOWLING GREEN KY
42104-1088
US

IV. Provider business mailing address

307 AMBER LN
WHITE HOUSE TN
37188-9562
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-6567
  • Fax:
Mailing address:
  • Phone: 615-681-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: