Provider Demographics
NPI:1306878251
Name:SAVELLI, BRENT A (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:A
Last Name:SAVELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 KENT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1649
Mailing Address - Country:US
Mailing Address - Phone:229-391-3555
Mailing Address - Fax:229-391-3560
Practice Address - Street 1:39 KENT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1649
Practice Address - Country:US
Practice Address - Phone:229-391-3555
Practice Address - Fax:229-391-3560
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000760812DMedicaid
GA0401686OtherUNITED HEALTHCARE
GA110235408Medicare PIN
GA000760812DMedicaid
GAG59722Medicare UPIN