Provider Demographics
NPI:1902882160
Name:SAVANNAH PLASTIC SURGICENTER
Entity Type:Organization
Organization Name:SAVANNAH PLASTIC SURGICENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-351-5050
Mailing Address - Street 1:7208 HODGSON MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2512
Mailing Address - Country:US
Mailing Address - Phone:912-351-5050
Mailing Address - Fax:912-351-5051
Practice Address - Street 1:7208 HODGSON MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2512
Practice Address - Country:US
Practice Address - Phone:912-351-5050
Practice Address - Fax:912-351-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
111041ASCAMedicare PIN