Provider Demographics
NPI:1992519433
Name:GERALD, SAVANNAH RAE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RAE
Last Name:GERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 US HIGHWAY 82 W STE 3&4
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8200
Mailing Address - Country:US
Mailing Address - Phone:229-445-3509
Mailing Address - Fax:229-445-3513
Practice Address - Street 1:1909 US HIGHWAY 82 W STE 3&4
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8200
Practice Address - Country:US
Practice Address - Phone:229-445-3509
Practice Address - Fax:229-445-3513
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN296848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily