| Provident Health Services, Inc. | |
|
4700 Waters Ave Memorial Health Hospitalists Savannah GA 31404-6220 | |
| (912) 350-2155 | |
| (912) 350-2156 |
| Full Name | Provident Health Services, Inc. |
|---|---|
| Speciality | Hospitalist |
| Location | 4700 Waters Ave, Savannah, Georgia |
| Authorized Official Name and Position | Robin J. Maddox (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Contact | 9123509335 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provident Health Services, Inc. 4700 Waters Ave Memorial Health Hospitalists Savannah GA 31404-6220 Ph: (912) 350-2155 | Provident Health Services, Inc. 4700 Waters Ave Memorial Health Hospitalists Savannah GA 31404-6220 Ph: (912) 350-2155 |
| NPI Number | 1093737041 |
|---|---|
| Provider Enumeration Date | 07/25/2006 |
| Last Update Date | 06/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093737041 | NPI | - | NPPES |
| 609293670A | Medicaid | GA | |
| GPA896 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208M00000X | Hospitalist | (* (Not Available)) | Primary |
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