Provider Demographics
NPI:1366488504
Name:NOVACK, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:NOVACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-5940
Mailing Address - Fax:912-350-5991
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-5940
Practice Address - Fax:912-350-5991
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA030168208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000398802DMedicaid
SCG30168Medicaid
GA260045914OtherRR MEDICARE
GA000398802CMedicaid
GA000398802DMedicaid
SCG30168Medicaid