# SJC MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811233828
- **Authorized official:** DONNA J STEPHENS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (912) 819-7878

## Contact information

- **Practice address:** 527 EISENHOWER DR, SAVANNAH, GA 31406-2668
- **Practice address phone:** (912) 819-9100
- **Practice address fax:** (912) 819-9100
- **Mailing address:** 602 E 72ND ST, SAVANNAH, GA 31405-4913
- **Mailing address phone:** (912) 819-7878
- **Mailing address fax:** (912) 819-7850

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |

## Other

- **Enumeration date:** 12/19/2012
- **Last updated:** 01/23/2017