Provider Demographics
NPI:1568638666
Name:MAZO, RUTH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:ANN
Last Name:MAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 14459
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1459
Mailing Address - Country:US
Mailing Address - Phone:912-790-4000
Mailing Address - Fax:912-790-4407
Practice Address - Street 1:230 E DERENNE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6736
Practice Address - Country:US
Practice Address - Phone:912-790-4068
Practice Address - Fax:912-790-4407
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA065481208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107870AMedicaid
GA003107870AMedicaid