Provider Demographics
NPI:1467467845
Name:SAVANNAH OBGYN PC
Entity Type:Organization
Organization Name:SAVANNAH OBGYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-355-8136
Mailing Address - Street 1:5356 REYNOLDS ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6016
Mailing Address - Country:US
Mailing Address - Phone:912-355-8136
Mailing Address - Fax:912-352-7014
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-355-8136
Practice Address - Fax:912-352-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00738955AMedicaid
GA00598001CMedicaid
GA00598001CMedicaid
GA00738955AMedicaid
GAE42592Medicare UPIN
GAR99017Medicare UPIN
GA16BDFDMMedicare ID - Type Unspecified