Provider Demographics
NPI:1699876037
Name:DENITTO, PAULA COLLETTE (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:COLLETTE
Last Name:DENITTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-2700
Mailing Address - Fax:912-350-2715
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-2700
Practice Address - Fax:912-350-2715
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27810208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000367243LMedicaid
GA10064371OtherAMERIGROUP
GA349748OtherWELLCARE
GA000367243FMedicaid
GA000367243HMedicaid
GA000367243EMedicaid
GA000367243JMedicaid
GA000367243IMedicaid
GA000367243KMedicaid
GAP00955053OtherRAILROAD MEDICARE
GA000367243GMedicaid
SCG27180Medicaid
D29276Medicare UPIN
GA000367243IMedicaid
GA000367243HMedicaid