Provider Demographics
NPI:1336366871
Name:ROSS, PRISCILLA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:JO
Last Name:ROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8880 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4508
Mailing Address - Country:US
Mailing Address - Phone:912-231-4444
Mailing Address - Fax:912-231-4440
Practice Address - Street 1:8880 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4508
Practice Address - Country:US
Practice Address - Phone:912-231-4444
Practice Address - Fax:912-231-4440
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2020-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC29455207LP2900X
GA058635207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA795441644HMedicaid
GA202I254680Medicare PIN