Provider Demographics
NPI:1528068210
Name:SCREVEN MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:SCREVEN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-564-2779
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-0219
Mailing Address - Country:US
Mailing Address - Phone:912-564-2779
Mailing Address - Fax:912-564-5888
Practice Address - Street 1:211 MIMS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1994
Practice Address - Country:US
Practice Address - Phone:912-564-2779
Practice Address - Fax:912-564-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI21535Medicare UPIN
GA11SCDLLMedicare ID - Type Unspecified