Individual
JOHNATHAN N BACICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
210 E DERENNE AVE, SAVANNAH, GA 31405-6736
(912) 644-5372
(912) 644-5260
Mailing address
210 E DERENNE AVE, SAVANNAH, GA 31405-6736
(912) 644-5300
(912) 644-5241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005124
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003158718A
—
GA
01
—
005124
PA LICENSE
GA
Enumeration date
09/20/2007
Last updated
05/08/2017
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