Organization
CYPRESS MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKY HENDLEY (OFFICE MANAGER)
(912) 839-2810
Entity
Organization
Contact information
Practice address
1499 FAIR RD, STATESBORO, GA 30458-1683
(912) 839-2810
(912) 839-2808
Mailing address
PO BOX 1957, STATESBORO, GA 30459-1957
(912) 839-2810
(912) 839-2808
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
55863
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003129950A
—
GA
01
—
202G700747
MEDICARE PTAN
GA
Enumeration date
06/25/2012
Last updated
12/31/2014
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