Provider Demographics
NPI:1184669301
Name:SAVANNAH NEPHROLOGY,PC
Entity Type:Organization
Organization Name:SAVANNAH NEPHROLOGY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-356-5171
Mailing Address - Street 1:5102 PAULSEN ST BLDG 7
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4624
Mailing Address - Country:US
Mailing Address - Phone:912-356-5171
Mailing Address - Fax:912-354-7401
Practice Address - Street 1:5102 PAULSEN ST BLDG 7
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4624
Practice Address - Country:US
Practice Address - Phone:912-356-5171
Practice Address - Fax:912-354-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037953174400000X
SC15425174400000X
GAR039856363LA2200X
SCR00079381363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACN4561OtherPALMETTO GBA/RR MEDICARE
GA00597583AMedicaid
GA00597583CMedicaid
SC154255Medicaid
GA00929255AMedicaid
GA39BDBSB05Medicare ID - Type UnspecifiedMEDICARE/SPRINGFIELD
GA00929255AMedicaid
SC154255Medicaid
GA50BBDSQMedicare ID - Type Unspecified
GA390002860Medicare ID - Type UnspecifiedRR MEDICARE
GA39BDBSB07Medicare PIN
GA00597583AMedicaid
GA00597583CMedicaid
GA39BDBSBMedicare ID - Type Unspecified
GAGRP3010Medicare PIN
GACN4561OtherPALMETTO GBA/RR MEDICARE
SCNP0564Medicare ID - Type UnspecifiedSC MEDICAID