Basic Information
| Provider Information | |||||||||
| NPI: | 1215080106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEMORIAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 WATERS AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123503438 | ||||||||
| FaxNumber: | 9123509037 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 WATERS AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123503438 | ||||||||
| FaxNumber: | 9123509037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SASSER | ||||||||
| AuthorizedOfficialFirstName: | GLENDA | ||||||||
| AuthorizedOfficialMiddleName: | LAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | BARIATRIC OUTPATIENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9123503438 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 363L00000X | GA | Y | Hospitals | General Acute Care Hospital |
No ID Information.