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NPI Code Detail

MEDICARE: INSTITUTE FOR PERSONALIZED MEDICINE

MEDICARE: INSTITUTE FOR PERSONALIZED MEDICINE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist55437GA

General Provider Information

NPI Number : 1326381690
Entity Type Code : Organization
Provider Name (Legal Business Name) : INSTITUTE FOR PERSONALIZED MEDICINE
Provider Business Mailing Address
First Line : 3 JOHNSTON ST
Second Line : SUITE B
City : SAVANNAH
State : GA
Zip : 31405-5502
Country : US
Telephone Number : 912-352-1234
Fax Number :
Provider Business Practice Location Address
First Line : 3 JOHNSTON ST
Second Line : SUITE B
City : SAVANNAH
State : GA
Zip : 31405-5502
Country : US
Telephone Number : 912-352-1234
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MARY KAY ROSS
Credential : MD
Telephone Number : 912-352-1234
Provider Enumeration Date : 04/04/2013
Last Update Date : 04/04/2013

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Directions to “INSTITUTE FOR PERSONALIZED MEDICINE ” Practice Location

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