Basic Information
| Provider Information | |||||||||
| NPI: | 1598220915 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EFFINGHAM UROLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 459 HIGHWAY 119 SOUTH | ||||||||
| Address2: | ATTN.: CREDENTIALING | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127540175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 613 TOWNE PARK DR W STE 204 | ||||||||
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| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127546451 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2019 | ||||||||
| LastUpdateDate: | 03/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | BAKER-WITT | ||||||||
| AuthorizedOfficialFirstName: | FRANCINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9127540142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.