Provider Demographics
NPI:1063473197
Name:SAVANNAH RADIOLOGISTS, PA
Entity Type:Organization
Organization Name:SAVANNAH RADIOLOGISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BROUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-7089
Mailing Address - Street 1:1 JOHNSTON STREET
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5531
Mailing Address - Country:US
Mailing Address - Phone:912-354-7089
Mailing Address - Fax:912-692-8957
Practice Address - Street 1:1 JOHNSTON STREET
Practice Address - Street 2:SUITE 12
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5531
Practice Address - Country:US
Practice Address - Phone:912-354-7089
Practice Address - Fax:912-692-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2085B0100X, 2085N0904X, 2085R0202X, 2085R0204X
2085N0700X
GA0344562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE05688Medicaid
GA55002191AMedicaid
GA156053200OtherOWCP
GA=========AMedicare ID - Type UnspecifiedMEDICARE GA
SC6289Medicare ID - Type UnspecifiedMEDICARE SC
SCE05688Medicaid