Healthcare Provider Details

I. General information

NPI: 1093530594
Provider Name (Legal Business Name): SAVANNAH COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVVY L COLE

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SAINT ANNES DR
HATTIESBURG MS
39401-8252
US

IV. Provider business mailing address

100 FOXGATE AVE APT 37A
HATTIESBURG MS
39402-2129
US

V. Phone/Fax

Practice location:
  • Phone: 601-447-4658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: