Provider Demographics
NPI:1912230434
Name:RILEY, CONSTANCE S
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:S
Last Name:RILEY
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 1:24 COMMERCE PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3699
Mailing Address - Country:US
Mailing Address - Phone:912-349-2091
Mailing Address - Fax:912-349-7456
Practice Address - Street 1:24 COMMERCE PL
Practice Address - Street 2:SUITE B
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3699
Practice Address - Country:US
Practice Address - Phone:912-349-2091
Practice Address - Fax:912-349-7456
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6450520001Medicare NSC