Provider Demographics
NPI:1528229549
Name:GEWANTER, DENA S (MD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:S
Last Name:GEWANTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENA
Other - Middle Name:G
Other - Last Name:EDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-303-3552
Mailing Address - Fax:
Practice Address - Street 1:5354 REYNOLDS ST STE 424
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6011
Practice Address - Country:US
Practice Address - Phone:912-819-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154824207R00000X
MEMD22577208M00000X
GA080154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA154824OtherMA REGISTRATION
MAG58544Medicare UPIN