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Individual

SHANA S. STANDARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
527 EISENHOWER DR, SAVANNAH, GA 31406-2668
(912) 819-9100
(912) 819-9101
Mailing address
836 E. 65TH STREET, SUITE 22, SAVANNAH, GA 31405
(912) 819-7878
(912) 819-3320

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003540
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01270783
AMERIGROUP
05
100000855C
GA
01
P00610133
RR MEDICARE
GA
Enumeration date
07/20/2006
Last updated
10/23/2024
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