Individual
MARY J PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
340 HODGSON CT, SUITE #2, SAVANNAH, GA 31406-1520
(912) 629-2290
(912) 629-2291
Mailing address
PO BOX 14417, SAVANNAH, GA 31416-1417
(912) 629-2290
(912) 629-2291
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
032635
GA
207RP1001X
Pulmonary Disease Physician
Primary
032635
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000473833F
—
GA
01
—
290011257
RAILROAD MEDICARE
GA
Enumeration date
03/09/2006
Last updated
05/10/2016
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