Individual
ALVARO HUMBERTO FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4750 WATERS AVE STE 202, SAVANNAH, GA 31404-6278
(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
208600000X
Surgery Physician
053906
GA
2086S0102X
Surgical Critical Care Physician
053906
GA
2086S0127X
Trauma Surgery Physician
Primary
053906
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10064458
AMERIGROUP
GA
01
—
349764
WELLCARE
GA
05
—
984016809A
—
GA
05
—
G53906
—
SC
01
—
P00358210
RR MEDICARE
GA
Enumeration date
06/17/2006
Last updated
01/26/2022
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