Provider Demographics
NPI:1295266955
Name:MEMORIAL SATILLA SPECIALISTS, LLC
Entity type:Organization
Organization Name:MEMORIAL SATILLA SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:FAILE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:843-956-7923
Mailing Address - Street 1:1921 ALICE ST STE B
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6200
Mailing Address - Country:US
Mailing Address - Phone:912-490-0722
Mailing Address - Fax:912-490-7227
Practice Address - Street 1:1921 ALICE ST STE B
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6200
Practice Address - Country:US
Practice Address - Phone:912-490-0722
Practice Address - Fax:912-490-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty