Organization
SAVANNAH NEPHROLOGY,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES K BAZEMORE MD (PRESIDENT)
(912) 356-5171
Entity
Organization
Contact information
Practice address
5102 PAULSEN ST BLDG 7, SAVANNAH, GA 31405-4624
(912) 356-5171
(912) 354-7401
Mailing address
5102 PAULSEN ST BLDG 7, SAVANNAH, GA 31405-4624
(912) 356-5171
(912) 354-7401
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
037953
GA
174400000X
Specialist
15425
SC
363LA2200X
Adult Health Nurse Practitioner
R00079381
SC
363LA2200X
Adult Health Nurse Practitioner
R039856
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00597583A
—
GA
05
—
00597583C
—
GA
05
—
00929255A
—
GA
05
—
154255
—
SC
01
—
CN4561
PALMETTO GBA/RR MEDICARE
GA
Enumeration date
06/19/2006
Last updated
12/16/2009
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