H Clark Deriso M.d.p.c.

NPI #1245412352 in Savannah, Georgia

Provider Information

NPI Number: 1245412352
Entity Type: Organization
Organization Name: H Clark Deriso M.d.p.c.
Subpart: Yes (part of a larger organization)
Parent Organization: H. CLARK DERISO M.D.P.C.
Primary Specialty: Specialist
Enumeration Date: Nov 30, 2007
Last Updated: Dec 6, 2007

Practice Location

Address: 38 MEDICAL ARTS CENTER
City: Savannah
State: Georgia
ZIP Code: 31405-4155
Phone: (912) 692-0755

Authorized Official

Name: DR. HENRY CLARK DERISO, M.D.
Title: MD
Phone: (972) 692-0755

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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