Provider Demographics
NPI:1760662464
Name:KIDNEY SPECIALISTS OF SAVANNAH PC
Entity type:Organization
Organization Name:KIDNEY SPECIALISTS OF SAVANNAH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:912-356-5643
Mailing Address - Street 1:1000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-3446
Mailing Address - Country:US
Mailing Address - Phone:912-356-5643
Mailing Address - Fax:912-356-9712
Practice Address - Street 1:1000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-3446
Practice Address - Country:US
Practice Address - Phone:912-356-5643
Practice Address - Fax:912-356-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA555Medicaid
SC8326Medicare PIN