=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518768126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VOICES OF SAVANNAH TN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2025
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 JV MANGUBAT DR STE A
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38485-2439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-436-5166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 435 MAIN ST E STE A
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38372-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-438-5166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEBORAH SHAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 731-438-5166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------