Organization
PROVIDENT HEALTH SERVICES, INC.
Active
Organization
PROVIDENT HEALTH SERVICES, INC.
Active
Other names
ACI Surgical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
(912) 350-2299
(912) 350-2298
Mailing address
PO BOX 933213, ATLANTA, GA 31193
(912) 350-2299
(912) 350-2298
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
Primary
—
—
Other
Enumeration date
12/13/2006
Last updated
11/11/2008
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