Provider Demographics
NPI:1265757058
Name:MURPHY, SAVANNAH RUTH (PA)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RUTH
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1237 HARDING PL
Practice Address - Street 2:STE 4300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08930363A00000X
TXPA06689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1265757058OtherBLUE CROSS BLUE SHIELD
TXP01254108OtherMEDICARE RR
TXP01030500OtherRR MEDICARE
TX213705102Medicaid
TX213705101Medicaid
TX8407NDOtherBLUE CROSS BLUE SHIELD
TX213705103Medicaid
TX1265757058OtherBLUE CROSS BLUE SHIELD
TX213705103Medicaid
TXTXB102518Medicare PIN