Provider Demographics
NPI:1750875183
Name:SAVANNAH HEALTH GROUP LLC
Entity type:Organization
Organization Name:SAVANNAH HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:AWINDA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-941-4034
Mailing Address - Street 1:1728 S WRIGHT CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2914
Mailing Address - Country:US
Mailing Address - Phone:801-941-4034
Mailing Address - Fax:813-336-8463
Practice Address - Street 1:4035 S 500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1866
Practice Address - Country:US
Practice Address - Phone:801-262-9181
Practice Address - Fax:813-336-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty