Basic Information
| Provider Information | |||||||||
| NPI: | 1154313229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | MORRIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15849 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314162549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125275301 | ||||||||
| FaxNumber: | 9127564740 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 INTERCHANGE DR | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313247661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125275301 | ||||||||
| FaxNumber: | 9127564740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 056565 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 848476628B | 05 | GA | MEDICAID | G56565 | 05 | SC | MEDICAID | P00253005 | 01 | GA | RR MEDICARE | OTHER | 848476628A | 05 | GA | MEDICAID |