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Organization
MPPG, INC.
Active
Organization
MPPG, INC.
Active
Other names
Rehabilitation Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
4750 WATERS AVE, SUITE 108, SAVANNAH, GA 31404-6200
(912) 350-5940
(912) 350-5991
Mailing address
4750 WATERS AVE, SUITE 108, SAVANNAH, GA 31404-6200
(912) 350-5940
(912) 350-5991
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/29/2006
Last updated
05/01/2012
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