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General NPI Number Information
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NPI Number | 1952599730
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Entity Type | Organization
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Legal Business Name | RENEWALMD STATESBORO
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 1209 MERCHANT WAY SUITE 301
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-920-2090
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Fax | 912-920-7921
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Provider Business Mailing Address
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Address Line | 900 MOHAWK STREET SUITE A
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City | SAVANNAH
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State | GA
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Zip | 31419-1780
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Country | US
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Telephone | 912-920-5624
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Fax | 912-920-7921
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Authorized Official
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Title or Position | PATIENT ACCOUNT MANAGER
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Name | BARBARA KEEL
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Credential | CPC, CPB, CPRC
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Telephone | 912-920-5624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 48571
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 45759
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 51685
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License Number State | GA
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