Organization
PROVIDENT HEALTH SERVICES, INC.
Active
Other names
Memorial Health Hospitalists
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, MEMORIAL HEALTH HOSPITALISTS, SAVANNAH, GA 31404-6220
(912) 350-2155
(912) 350-2156
Mailing address
4700 WATERS AVE, MEMORIAL HEALTH HOSPITALISTS, SAVANNAH, GA 31404-6220
(912) 350-2155
(912) 350-2156
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
609293670A
—
GA
01
—
DA3772
RR MEDICARE
GA
01
—
DF7661
RR MEDICARE
SC
05
—
GPA921
—
SC
Enumeration date
12/13/2006
Last updated
06/04/2009
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