Organization
MPPG, INC.
Active
Other names
Savannah Surgical Group
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
4750 WATERS AVE, SUITE 202, SAVANNAH, GA 31404-6200
(912) 350-7412
(912) 350-7297
Mailing address
4750 WATERS AVE, SUITE 202, SAVANNAH, GA 31404-6200
(912) 350-7412
(912) 350-7297
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPA611
—
SC
Enumeration date
11/29/2006
Last updated
10/04/2011
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