Provider Demographics
NPI:1912280694
Name:PERINATAL CENTER OF SAVANNAH
Entity Type:Organization
Organization Name:PERINATAL CENTER OF SAVANNAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:912-721-9499
Mailing Address - Street 1:5354 REYNOLDS ST
Mailing Address - Street 2:SUITE 422
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6007
Mailing Address - Country:US
Mailing Address - Phone:912-721-9499
Mailing Address - Fax:912-721-9518
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:SUITE 422
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-721-9499
Practice Address - Fax:912-721-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57459207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty