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Organization

PROVIDENT HEALTH SURGICAL ASSOCIATES

Active
Other names
ACI Surgical Associates
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization

Contact information

Practice address
4700 WATERS AVE, SUITE 403, SAVANNAH, GA 31404-6220
(912) 350-2299
(912) 350-2298
Mailing address
4700 WATERS AVE, SUITE 403, SAVANNAH, GA 31404-6220
(912) 350-2299
(912) 350-2298

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2086X0206X
Surgical Oncology Physician

Other

Enumeration date
08/02/2011
Last updated
08/02/2011
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