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General NPI Number Information
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NPI Number | 1235709601
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Entity Type | Organization
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Legal Business Name | SAVANNAH INTEGRATIVE PEDIATRICS
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 132 STEPHENSON AVE SUITE 201
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City | SAVANNAH
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State | GA
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Zip | 31405-3140
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Country | US
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Telephone | 912-567-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 132 STEPHENSON AVE SUITE 201
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City | SAVANNAH
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State | GA
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Zip | 31405-8900
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Country | US
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Telephone | 912-567-3700
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SOMMER CLARK
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Credential | ANRP
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Telephone | 912-508-3983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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