Provider Demographics
NPI:1023189701
Name:PHOENIX CLINIC
Entity Type:Organization
Organization Name:PHOENIX CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO LIAISON
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-356-2887
Mailing Address - Street 1:2 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5700
Mailing Address - Country:US
Mailing Address - Phone:912-231-1971
Mailing Address - Fax:912-232-7423
Practice Address - Street 1:525 E 34TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-8149
Practice Address - Country:US
Practice Address - Phone:912-356-2953
Practice Address - Fax:912-356-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAFLU230Medicare ID - Type UnspecifiedFLU
GAGRP1660Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
GAFLU231Medicare ID - Type UnspecifiedPNEUMONIA