Organization
SAVANNAH DIAGNOSTIC ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DAVID NORTHUP M.D. (PRESIDENT)
(912) 927-3046
Entity
Organization
Contact information
Practice address
12345 MERCY BLVD, SAVANNAH, GA 31419-3436
(912) 927-3048
(912) 925-0597
Mailing address
12345 MERCY BLVD, SAVANNAH, GA 31419-3436
(912) 927-3048
(912) 925-0597
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
016651
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000018092A
—
GA
01
—
52241377
BLUE CROSS BLUE SHIELD
GA
Enumeration date
07/07/2005
Last updated
07/19/2010
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