Provider Demographics
NPI:1902976152
Name:PROVISOR, ARTHUR J (MD)
Entity type:Individual
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First Name:ARTHUR
Middle Name:J
Last Name:PROVISOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4750 WATERS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6267
Mailing Address - Country:US
Mailing Address - Phone:912-350-5646
Mailing Address - Fax:912-350-7680
Practice Address - Street 1:1800 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-571-1120
Practice Address - Fax:706-660-1603
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2018-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0473582080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00834655BMedicaid
GAB28204Medicare UPIN