| Dr Heather Morgan Wallace, MD | |
|
230 E Derenne Ave, Savannah, GA 31405-6736 | |
| (912) 790-4000 | |
| (912) 790-4407 |
| Full Name | Dr Heather Morgan Wallace |
|---|---|
| Gender | Female |
| Speciality | Urology |
| Location | 230 E Derenne Ave, Savannah, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336173574 | NPI | - | NPPES |
| 00857566 | Medicaid | MS | |
| P00462352 | Other | MS | RR MEDICARE |
| 003131576D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 18108 (Mississippi) | Primary |
| Entity Name | Southcoast Medical Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467451922 PECOS PAC ID: 9032013271 Enrollment ID: O20040109000192 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Heather Morgan Wallace, MD Po Box 14459, Savannah, GA 31416-1459 Ph: (912) 790-4000 | Dr Heather Morgan Wallace, MD 230 E Derenne Ave, Savannah, GA 31405-6736 Ph: (912) 790-4000 |
Dr. Thomas Earl Shook, MD, MPH Urology Medicare: Accepting Medicare Assignments Practice Location: 230 E Derenne Ave, Savannah, GA 31405 Phone: 912-790-4000 Fax: 912-790-4407 | |
Dr. David L Cheng, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 230 E Derenne Ave, Savannah, GA 31405 Phone: 912-790-4000 Fax: 912-790-4407 | |
Dr. Michael Jon Cox, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 230 E Derenne Ave, Savannah, GA 31405 Phone: 912-790-4000 Fax: 912-790-4407 | |
Adam Jenks, MD Urology Medicare: Medicare Enrolled Practice Location: 230 E Derenne Ave, Savannah, GA 31405 Phone: 912-790-4000 | |
Andrew Michigan, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 230 E Derenne Ave, Savannah, GA 31405 Phone: 912-790-4000 | |
Dr. Ruth Ann Mazo, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 230 E Derenne Ave, Savannah, GA 31405 Phone: 912-790-4068 Fax: 912-790-4407 |