Organization
PRIVIA MEDICAL GROUP OF GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN CLANCY (SENIOR VICE PRESIDENT)
(571) 366-8845
Entity
Organization
Contact information
Practice address
1326 EISENHOWER DR BLDG 1, SAVANNAH, GA 31406-3928
(571) 366-8850
Mailing address
950 N GLEBE RD STE 4000, ARLINGTON, VA 22203-1824
(571) 366-8850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7787550001
MEDICARE DME
—
Enumeration date
05/16/2019
Last updated
02/26/2020
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