Provident Health Surgical Associates

NPI #1508144981 in Savannah, Georgia

Provider Information

NPI Number: 1508144981
Entity Type: Organization
Organization Name: Provident Health Surgical Associates
Primary Specialty: Surgery
Enumeration Date: Aug 2, 2011
Last Updated: Aug 2, 2011

Practice Location

Address: 4700 WATERS AVE
Address 2: SUITE 403
City: Savannah
State: Georgia
ZIP Code: 31404-6220
Phone: (912) 350-2299

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Surgery - Surgical Oncology — Surgical Oncology	2086X0206X
Surgery	208600000X	Primary

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