Provident Health Surgical Associates, Inc.

NPI #1104113307 in Savannah, Georgia

Provider Information

NPI Number: 1104113307
Entity Type: Organization
Organization Name: Provident Health Surgical Associates, Inc.
Primary Specialty: Surgery
Enumeration Date: Jul 8, 2011
Last Updated: Jul 8, 2011

Practice Location

Address: 4700 WATERS AVE
Address 2: SUITE 405
City: Savannah
State: Georgia
ZIP Code: 31404-6220
Phone: (912) 350-2700

Authorized Official

Name: MRS. ROBIN J. MADDOX
Title: PROVIDER ENROLLMENT COORDINATOR
Phone: (912) 350-9335

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X
Surgery	208600000X	Primary

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