# PROVIDENT HEALTH SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clinical Genetics Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679634612
- **Authorized official:** ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
- **Authorized official phone:** (912) 350-9335

## Contact information

- **Practice address:** 4700 WATERS AVE, SAVANNAH, GA 31404-6220
- **Practice address phone:** (912) 350-8490
- **Practice address fax:** (912) 350-8199
- **Mailing address:** PO BOX 933213, ATLANTA, GA 31193-3213
- **Mailing address phone:** (912) 350-8490
- **Mailing address fax:** (912) 350-8199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | NULL | Yes |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | Yes |
| 207SG0203X | Clinical Molecular Genetics Physician | — | NULL | — |
| 207SG0203X | Clinical Molecular Genetics Physician | — | — | — |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 11/12/2007