Provider Demographics
NPI:1508850231
Name:PEDIATRIC ASSOCIATES OF SAVANNAH, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF SAVANNAH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-355-2462
Mailing Address - Street 1:4600 WATERS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6702
Mailing Address - Country:US
Mailing Address - Phone:912-355-2462
Mailing Address - Fax:912-353-1836
Practice Address - Street 1:4600 WATERS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6702
Practice Address - Country:US
Practice Address - Phone:912-355-2462
Practice Address - Fax:912-353-1836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA085001460GMedicaid
GA=========OtherTAX ID #