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General NPI Number Information
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NPI Number | 1407910169
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF GEORGIA MEDICAL, P.C.
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 836 EAST 65TH STREET, 4 MEDICAL ARTS
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City | SAVANNAH
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State | GA
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Zip | 31405-4491
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Country | US
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Telephone | 912-351-0057
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Fax | 912-351-0074
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Provider Business Mailing Address
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Address Line | 16906 COLLECTION CENTER DR
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City | CHICAGO
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State | IL
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Zip | 60693-0169
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Country | US
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Telephone | 877-865-9013
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Fax | 217-709-2345
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON LEIZMAN
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Credential | M.D.
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Telephone | 216-479-9603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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