Provider Demographics
NPI:1275532756
Name:SAVANNAH SURGICAL ONCOLOGY, LLC
Entity Type:Organization
Organization Name:SAVANNAH SURGICAL ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-303-3552
Mailing Address - Street 1:7001 HODGSON MEMORIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2549
Mailing Address - Country:US
Mailing Address - Phone:912-303-3552
Mailing Address - Fax:912-303-3506
Practice Address - Street 1:7001 HODGSON MEMORIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2549
Practice Address - Country:US
Practice Address - Phone:912-303-3552
Practice Address - Fax:912-303-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA874Medicaid
GADC2503Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GAGRP6428Medicare ID - Type Unspecified