Provider Demographics
NPI:1033139191
Name:MCCOURT, MARY E (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 EISENHOWER DRIVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-443-4200
Mailing Address - Fax:912-350-0602
Practice Address - Street 1:340 EISENHOWER DRIVE
Practice Address - Street 2:SUITE 1200
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-443-4200
Practice Address - Fax:912-350-0602
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBHCQOtherMEDICARE PIN UNDER OLD GROUP/TIN
GAP00630160OtherRR MEDICARE
GA000814195EMedicaid
GAS44987Medicare UPIN
GAP00630160OtherRR MEDICARE
GA000814195EMedicaid