Provider Demographics
NPI:1487640538
Name:DELOACH, ERVIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:D
Last Name:DELOACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 HODGSON MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2512
Mailing Address - Country:US
Mailing Address - Phone:912-351-5050
Mailing Address - Fax:912-351-5051
Practice Address - Street 1:7208 HODGSON MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2512
Practice Address - Country:US
Practice Address - Phone:912-351-5050
Practice Address - Fax:912-351-5051
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16708208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00192497AMedicaid
GA00192497AMedicaid