Provider Demographics
NPI:1184075012
Name:KOLOVICH, MARTINA
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:KOLOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MOHAWK ST
Mailing Address - Street 2:STE E
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1844
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-925-2381
Practice Address - Street 1:900 MOHAWK ST
Practice Address - Street 2:STE E
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1844
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:912-925-2381
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240475363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology