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
7 MALLET WAY, BLUFFTON, SC 29910-6064
(912) 350-7412
(912) 350-7297
Mailing address
PO BOX 933213, ATLANTA, GA 31193-1968
(912) 350-7412
(912) 350-7297
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086X0206X
Surgical Oncology Physician
—
—
Other
Enumeration date
11/30/2006
Last updated
09/11/2025
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