Healthcare Provider Details

I. General information

NPI: 1104755297
Provider Name (Legal Business Name): SAVANNA SMALLWOOD-CORCORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CLARK SUMMIT DR STE F201
BLUFFTON SC
29910-4205
US

IV. Provider business mailing address

1030 JACK PRIMUS RD APT 6208
CHARLESTON SC
29492-5012
US

V. Phone/Fax

Practice location:
  • Phone: 843-757-4737
  • Fax:
Mailing address:
  • Phone: 443-282-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number30245
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: