Provider Demographics
NPI:1942992441
Name:SUTHERLAND, SAVANNAH JANE (DO)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JANE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MDG/GME 301 FISHER ST, RM 1G123 KEESLER AFB
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39534
Mailing Address - Country:US
Mailing Address - Phone:850-491-2300
Mailing Address - Fax:
Practice Address - Street 1:81 MDG/GME 301 FISHER ST, RM 1G123 KEESLER AFB
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:850-491-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program