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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