Provider Demographics
NPI:1114987757
Name:PENDLETON, ANDREW L (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:PENDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6267
Mailing Address - Country:US
Mailing Address - Phone:912-350-5646
Mailing Address - Fax:912-350-5697
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8180
Practice Address - Fax:912-350-5697
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0674292080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122073CMedicaid
SCGA1313Medicaid
GAP01059892OtherRAILROAD MEDICARE
GA003122073BMedicaid
GA003122073CMedicaid
GAP01059892OtherRAILROAD MEDICARE