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General NPI Number Information
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NPI Number | 1851828321
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Entity Type | Organization
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Legal Business Name | USCG CLINIC SAVANNAH
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 300 E MAIN ST
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City | NORFOLK
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State | VA
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Zip | 23510-1753
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Country | US
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Telephone | 757-628-4363
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Fax |
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Provider Business Mailing Address
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Address Line | 1297 N LIGHTNING RD
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City | SAVANNAH
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State | GA
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Zip | 31409-4703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HEALTH SYSTEM ANALYST
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Name | DEBRA FITZGERALD
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Credential |
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Telephone | 757-628-4363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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