Individual
MIRIAM LONGWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1128 E DERENNE AVE, SAVANNAH, GA 31406
(912) 231-7900
Mailing address
5 WYCKFIELD CT, SAVANNAH, GA 31410-3916
(912) 308-5142
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA002331
GA
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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