Provider Demographics
NPI:1629251699
Name:SAVANNAH ENDOCRINE & DIABETES P.C.
Entity Type:Organization
Organization Name:SAVANNAH ENDOCRINE & DIABETES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:GERBSCH
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:912-355-6029
Mailing Address - Street 1:340 EISENHOWER DR
Mailing Address - Street 2:#1600
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1600
Mailing Address - Country:US
Mailing Address - Phone:912-355-6029
Mailing Address - Fax:912-352-3071
Practice Address - Street 1:340 EISENHOWER DR
Practice Address - Street 2:#1600
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1600
Practice Address - Country:US
Practice Address - Phone:912-355-6029
Practice Address - Fax:912-352-3071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAVANNAH ENDOCRINE & DIABETES P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29616Medicare UPIN