Individual
DR. HENRY CLARK DERISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
38 MEDICAL ARTS CTR, SAVANNAH, GA 31405-4415
(912) 692-0755
(912) 692-0754
Mailing address
38 MEDICAL ARTS CTR, SAVANNAH, GA 31405-4415
(912) 692-0755
(912) 692-0754
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
013026
GA
Other
Enumeration date
09/21/2006
Last updated
12/06/2007
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