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General NPI Number Information
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NPI Number | 1508704347
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Entity Type | Organization
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Legal Business Name | SAVANNAH RIVER ADVANCED SURGERY
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 728 MICHAELS CRK
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City | EVANS
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State | GA
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Zip | 30809-4042
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Country | US
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Telephone | 202-430-5326
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Fax |
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Provider Business Mailing Address
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Address Line | 728 MICHAELS CRK
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City | EVANS
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State | GA
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Zip | 30809-4042
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Country | US
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Telephone | 202-430-5326
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Fax |
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Authorized Official
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Title or Position | CEO AND FOUNDER
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Name | DR. JUAQUITO MARIO JORGE
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Credential | MD
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Telephone | 312-523-1424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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