Provider Demographics
NPI:1922047471
Name:DEVARO, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:DEVARO
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 1:340 EISENHOWER DR
Mailing Address - Street 2:BLDG 1400 SUITE A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1600
Mailing Address - Country:US
Mailing Address - Phone:912-353-1001
Mailing Address - Fax:912-353-1026
Practice Address - Street 1:340 EISENHOWER DR. BLDG 1400
Practice Address - Street 2:SUITE A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-353-1001
Practice Address - Fax:912-353-1026
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043595207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000750307GMedicaid
GA511G701067OtherGA MEDICARE
GA511G701067OtherGA MEDICARE
F41706Medicare UPIN
GA0412940001Medicare NSC
SCQ35628Medicaid
GA0412940005Medicare NSC
GA00750307AMedicaid
GA0412940007Medicare NSC
GA18BDFDDMedicare PIN