Organization
MPPG, INC.
Active
Other names
Savannah Vascular Surgery, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
1601 FAIR RD, STATESBORO, GA 30458-1698
(912) 350-5961
(912) 350-5942
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(912) 350-5961
(912) 350-5942
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
11/30/2006
Last updated
06/01/2011
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