Provider Demographics
NPI:1821014853
Name:HERMAN, STEPHEN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HOVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2500
Mailing Address - Country:US
Mailing Address - Phone:912-920-2424
Mailing Address - Fax:404-592-9751
Practice Address - Street 1:130 TIBET AVE
Practice Address - Street 2:STE 206
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-9028
Practice Address - Country:US
Practice Address - Phone:912-777-8454
Practice Address - Fax:912-525-3212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD21520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D40125Medicare UPIN
GA00331537CMedicaid
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