Provider Demographics
NPI:1912326893
Name:GASTROENTEROLOGY CONSULTANTS OF SAVANNAH, PC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF SAVANNAH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:OSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-721-6655
Mailing Address - Street 1:519 STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5969
Mailing Address - Country:US
Mailing Address - Phone:912-354-9447
Mailing Address - Fax:912-355-6430
Practice Address - Street 1:10 OAK FOREST RD STE B
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4974
Practice Address - Country:US
Practice Address - Phone:843-815-3006
Practice Address - Fax:843-815-3737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTROENTEROLOGY CONSULTANTS OF SAVANNAH, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25219085207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP105OtherMEDICARE
GA55000984AMedicaid