Organization
H CLARK DERISO M.D.P.C.
Active
Parent organization
H. CLARK DERISO M.D.P.C.
Other names
H. Clark Deriso M.D.P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
H. CLARK DERISO M.D.P.C.
Authorized official
DR. HENRY CLARK DERISO M.D. (MD)
(972) 692-0755
Entity
Organization
Contact information
Practice address
38 MEDICAL ARTS CENTER, SAVANNAH, GA 31405-4155
(912) 692-0755
(912) 692-0754
Mailing address
38 MEDICAL ARTS CTR, SAVANNAH, GA 31405-4415
(912) 692-0755
(912) 692-0754
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
013026
GA
Other
Enumeration date
11/30/2007
Last updated
12/06/2007
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