=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629251699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVANNAH ENDOCRINE & DIABETES P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2007
-----------------------------------------------------
Last Update Date | 12/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 EISENHOWER DR #1600
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31406-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-355-6029
-----------------------------------------------------
Fax | 912-352-3071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 EISENHOWER DR #1600
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31406-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-355-6029
-----------------------------------------------------
Fax | 912-352-3071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. ELISE GERBSCH GRESHAM
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 912-355-6029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 026286
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------