Provider Demographics
NPI:1346427879
Name:PHILIP R. SALEEBY, M.D., P.C.
Entity Type:Organization
Organization Name:PHILIP R. SALEEBY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SALEEBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-265-6344
Mailing Address - Street 1:3212 SHRINE RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4325
Mailing Address - Country:US
Mailing Address - Phone:912-265-6344
Mailing Address - Fax:912-265-6347
Practice Address - Street 1:3212 SHRINE RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4325
Practice Address - Country:US
Practice Address - Phone:912-265-6344
Practice Address - Fax:912-265-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00193509AMedicaid
GA00950OtherBLUE CROSS BLUE SHIELD
GA1558343293OtherPHILIP R. SALEEBY M.D.
GA340890OtherWELLCARE
GA10062344OtherAMERIGROUP
GA00193509AMedicaid