Provider Demographics
NPI:1235709601
Name:SAVANNAH INTEGRATIVE PEDIATRICS
Entity Type:Organization
Organization Name:SAVANNAH INTEGRATIVE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:ANRP
Authorized Official - Phone:912-508-3983
Mailing Address - Street 1:132 STEPHENSON AVE SUITE 201
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-8900
Mailing Address - Country:US
Mailing Address - Phone:912-567-3700
Mailing Address - Fax:
Practice Address - Street 1:132 STEPHENSON AVE SUITE 201
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3140
Practice Address - Country:US
Practice Address - Phone:912-567-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty