Individual
MARY KAY ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
(912) 350-3849
Mailing address
3 JOHNSTON ST, SAVANNAH, GA 31405-5502
(912) 352-1234
(912) 352-0492
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
55437
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000727504B
PEACH STATE HEALTH PLAN
GA
05
—
000727504B
—
GA
01
—
10064506
AMERIGROUP
GA
01
—
215114
BLUE CROSS BLUE SHIELD
GA
01
—
N362168
WELLCARE
GA
05
—
Q21432
—
SC
Enumeration date
05/19/2006
Last updated
03/07/2023
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