Provider Demographics
NPI:1932376324
Name:SAVANNAH MEDICAL CENTER PC
Entity type:Organization
Organization Name:SAVANNAH MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-925-8016
Mailing Address - Street 1:255 WAYNE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1947
Mailing Address - Country:US
Mailing Address - Phone:731-925-8016
Mailing Address - Fax:731-925-9514
Practice Address - Street 1:255 WAYNE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-1947
Practice Address - Country:US
Practice Address - Phone:731-925-8016
Practice Address - Fax:731-925-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD08334208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3848294Medicaid
TN3848294Medicare PIN