Provider Demographics
NPI:1649219429
Name:FABRIZIO, ADRIENNE V R (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:V R
Last Name:FABRIZIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:VICTORIA
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:STE 12A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-201-1140
Mailing Address - Fax:
Practice Address - Street 1:310 EISENHOWER DR STE 12A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-201-1140
Practice Address - Fax:912-352-4065
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA349759OtherWELLCARE MEDICAID
GA619151OtherWELLCARE
GA890274OtherBLUE CROSS BLUE SHIELD
GA000926978CMedicaid
SCG50365Medicaid
GA000926978AMedicaid
GA10064422OtherAMERIGROUP
110234552OtherRAILROAD MEDICARE
GA000926978CMedicaid
GA890274OtherBLUE CROSS BLUE SHIELD