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General NPI Number Information
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NPI Number | 1700038924
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Entity Type | Organization
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Legal Business Name | SAVANNAH RIVER DERMATOLOGY LLC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 575 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9059
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Country | US
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Telephone | 706-691-7079
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Fax | 706-364-0416
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Provider Business Mailing Address
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Address Line | 575 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9059
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Country | US
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Telephone | 706-691-7079
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Fax | 706-364-0416
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANNA K DUCKWORTH
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Credential |
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Telephone | 706-691-7079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 060452
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License Number State | GA
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